Single-Center Experience of Cerebral Artery Thrombectomy Using the TREVO Device in 60 Patients With Acute Ischemic Stroke

Abstract

Background and Purpose-We sought to explore the safety and efficacy of the new TREVO stent-like retriever in consecutive patients with acute stroke. Methods-We conducted a prospective, single-center study of 60 patients (mean age, 71.3 years; male 47%) with stroke lasting Ͻ8 hours in the anterior circulation (nϭ54) or Ͻ12 hours in the vertebrobasilar circulation (nϭ6) treated if CT perfusion/CT angiography confirmed a large artery occlusion, ruled out a malignant profile, or showed target mismatch if symptoms Ͼ4.5 hours. Successful recanalization (Thrombolysis In Cerebral Infarction 2b-3), good outcome (modified Rankin Scale score 0 -2) and mortality at Day 90, device-related complications, and symptomatic hemorrhage (parenchymal hematoma Type 1 or parenchymal hematoma Type 2 and National Institutes of Health Stroke Scale score increment Ն4 points) were prospectively assessed. Results-Median (interquartile range) National Institutes of Health Stroke Scale score on admission was 18 (12-22). The median (interquartile range) time from stroke onset to groin puncture was 210 (173-296) minutes. Successful revascularization was obtained in 44 (73.3%) of the cases when only the TREVO device was used and in 52 (86.7%) when other devices or additional intra-arterial tissue-type plasminogen activator were also required. The median time (interquartile range) of the procedure was 80 (45-114) minutes. Good outcome was achieved in 27 (45%) of the patients and the mortality rate was 28.3%. Seven patients (11.7%) presented a symptomatic intracranial hemorrhage. No other major complications were detected. Conclusions-The TREVO device was reasonably safe and effective in patients with severe stroke. These results support further investigation of the TREVO device in multicentric registries and randomized clinical trials. (Stroke.

Retrospective Multicenter Study of Solitaire FR for Revascularization in the Treatment of Acute Ischemic Stroke

“…TREVO has also shown a high rate of revascularization (by Corelab TICI 2a, 2b, or 3; 90%) and favorable outcome (57%) in a multicenter single arm trial of 60 patients with acute stroke (N. Wahlgren N, ISC, New Orleans, LA, 2012) and in a recent single center experience (TICI 2b or 3, 73%; good outcome, 45%). 22 Newer revascularization concepts like the use of stentbased thrombectomy devices achieve revascularization rates of 90%; however, there still remains a mismatch between revascularization and clinical outcome, particularly in cases with delay in initiation and successful revascularization with intra-arterial therapy. The Solitaire FR device is a valuable addition to the armamentarium of acute stroke intervention tools because complete thrombus removal is safely achieved in many patients within a short time.…”

What Is Meant by “TICI”?

“…Thirteen (18%) articles used TICI but did not define the scale and did not cite the original TICI paper. 13,30,56,[66][67][68][69][70][71][72][73][74][75] These results are depicted in Fig 1. Eighteen (24%) of articles mentioned the rate of contrast filling in their use of TICI. Most modifications of TICI eliminated the subcategories of 2a and 2b.…”

Stent-Based Thrombectomy Versus Intravenous Tissue Plasminogen Activator in Patients With Acute Middle Cerebral Artery Occlusion

“…4,7,8 Reassuringly, SBT was not associated with increasing symptomatic intracranial hemorrhage rates despite the prolonged onset-to-treatment time.…”

“…Thus, the use of stent-based thrombectomy (SBT) recently has emerged as a safe and promising modality. 4,7,8 Therefore, our goal was to examine whether SBT may be comparable with tPA in a selective group of patients with pMCAO.…”