Background With the clear Class I, Level of Evidence A indication that thrombectomy for acute stroke is beneficial, the intervention community must now work to continue to improve outcomes and refine thrombectomy technique. Embolic events can occur in up to 12% of cases of Stentriever thrombectomy and are associated with a 2-fold increase in mortality compared with cases without embolic complications.1 The Cover embolization protection device (Lazarus Effect, Campbell, California, USA) is a novel nitinol-braided mesh device that surrounds stent retrieval devices and thrombus during thrombectomy to mitigate clot fragmentation and embolization.
Methods We report out initial experience using this novel technology. We report rates of target vessel recanalization and embolization in new territories achieved with the Cover device used in conjunction with 2 Stentrievers, the Solitaire Flow Restoration FR (Covidien, Irvine, California) and the Trevo XP Retrieval System (Stryker Neurovascular, Freemont, CA).
Results In a total of 10 patients, 10 thrombectomy procedures were performed. Large vessel occlusions concerned 6 M1, 3 M2 and 1 tandem (ICA + M1). Successful recanalization (TICI 2b-3) was achieved after only one pass in 6 out of the 9 cases of isolated M1 or M2 occlusions (4 with the Trevo XP, 2 with the Solitaire FR systems). For the case of tandem occlusion, the M1 segment was cleared in one pass (Solitaire FR) after cervical ICA balloon angioplasty followed by ICA clot debulking with the ADAPT technique. Overall, TICI 2B or 3 was obtained in 9 out of the 10 cases (6 cases with the Trevo XP, 3 cases with the Solitaire FR). Embolization of new (previously unaffected) territories occurred in none of the 10 patients.
Application of the Cover device when performing acute stroke thrombectomy is feasible, appears to be safe, and may result in good successful recanalization rates with less embolic events.
Gascou G, Lobotesis K, Machi P, et al. Stent retrievers in acute ischemic stroke: complications and failures during the perioperative period. AJNR Am J Neuroradiol 2014;35:734–40
Disclosures M. Piotin: 4; C; Lazarus Effect. B. Bartolini: None. H. Redjem: None. P. Paraschakis: None. R. Blanc: 4; C; Lazarus Effect.
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