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Original research
Mechanical thrombectomy with the Trevo ProVue device in ischemic stroke patients: does improved visibility translate into a clinical benefit?
  1. Christoph Kabbasch1,
  2. Anastasios Mpotsaris1,
  3. De-Hua Chang1,
  4. Sonja Hiß1,
  5. Franziska Dorn1,
  6. Daniel Behme2,
  7. Oezguer Onur3,
  8. Thomas Liebig1
  1. 1Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
  2. 2Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany
  3. 3Department of Neurology, University Hospital of Cologne, Cologne, Germany
  1. Correspondence to Dr T Liebig, Department of Radiology and Neuroradiology, University Hospital of Cologne, Kerpener Str 62, Cologne 50937, Germany; thomas.liebig{at}uk-koeln.de

Abstract

Purpose To investigate the efficacy and safety of the Trevo ProVue (TPV) stent retriever in stroke patients with large artery occlusions, with particular attention to the full structural radiopacity of the TPV.

Materials and methods Case files and images of TPV treatments were reviewed for clinical and technical outcome data, including revascularization rates, device and procedure related complications, and outcome at discharge and after 90 days.

Results 76 patients were treated with TPV. Mean National Institutes of Health Stroke Scale (NIHSS) score was 18 and 68% had additional intravenous thrombolysis. 63 occlusions were in the anterior circulation: 44 M1 (58%), 8 M2 (11%), 8 internal carotid artery-terminus (11%), 2 internal carotid artery- left (3%), 1 A2 (1%), and 13 vertebrobasilar (17%). 58 of 76 (76%) were solely treated with TPV; the remainder were treated with additional stent retrievers. Mean number of passes in TPV only cases was 2.2 (SD 1.2). In rescue cases, 3.2 (SD 2.2) passes were attempted with the TPV followed by 2.6 rescue device passes (SD 2). TPV related adverse events occurred in 4/76 cases (5%) and procedural events in 6/76 cases (8%). Mean procedural duration was 64 min (SD 42). Thrombolysis in Cerebral Infarction (TICI) 2b/3 recanalization was achieved in 69/76 patients (91%), including 50% TICI 3. Of 56 survivors (74%), 37 (49%) showed a favorable outcome at 90 days (Solitaire With the Intention for Thrombectomy trial criteria), statistically associated with age, baseline NIHSS, onset to revascularization time, and TICI 2b–3 reperfusion. TPV radiopacity allowed for visual feedback, changing the methodology of stent retriever use in 44/76 cases (58%).

Conclusions Neurothrombectomy with TPV is feasible, effective, and safe. The recanalization rate compares favorably with reported data in the literature. Improved structural radiopacity may facilitate neurothrombectomy or influence the course of action during retrieval.

  • Stroke
  • Thrombectomy
  • Intervention
  • Angiography

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