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Original research
A comparative analysis of 3MAX aspiration versus 3 mm Trevo Retriever for distal occlusion thrombectomy in acute stroke
  1. Diogo C Haussen1,
  2. Brendan Eby,
  3. Alhamza R Al-Bayati2,
  4. Jonathan A Grossberg3,
  5. Gabriel Martins Rodrigues,
  6. Michael R Frankel4,5,
  7. Raul G Nogueira
  1. 1 Neurology, Neurosurgery and Radiology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Atlanta, Georgia, USA
  2. 2 Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3 Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
  4. 4 Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  5. 5 Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
  1. Correspondence to Dr. Raul G Nogueira; raul.g.nogueira{at}


Background Although aspiration and stent retriever thrombectomy perform similarly in proximal occlusions, no comparative series are available in distal occlusions. We aimed to compare the 3 mm Trevo Retriever against the 3MAX thromboaspiration catheter in distal arterial occlusions.

Methods A single-center retrospective review of a prospectively maintained databank for patients treated with the 3 mm Trevo stent retriever or 3MAX thromboaspiration as the upfront approach for distal occlusions (middle cerebral artery mid/distal M2/M3, anterior cerebral artery A1/A2/A3 or posterior cerebral artery P1/P2) from January 2014 to July 2018 was performed. The primary outcome was the rate of distal occlusion first-pass reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2b–3).

Results Of 1100 patients treated within the study period, 137 patients/144 different arteries were treated with the 3 mm Trevo (n=92) or 3MAX device (n=52). The groups had comparable demographics and baseline characteristics. There was a higher rate of first-pass mTICI 2b–3 reperfusion (62% vs 44%; p=0.03), a trend towards a higher rate of final mTICI 2b–3 reperfusion (84% vs 69%; p=0.05), and lower use of adjuvant therapy (15% vs 31%; p=0.03) with the 3 mm Trevo compared with the 3MAX. The median number of passes (p=0.46), frequency of arterial spasm (p=1.00), rates of parenchymal hematomas (p=0.22)/subarachnoid hemorrhage (p=0.37) in the territory of the approached vessel were similar across the two groups. The 90-day rate of good outcomes (45% vs 46% in the 3 mm Trevo and 3MAX groups, respectively; p=0.84) was comparable. Multivariable regression identified baseline NIH Stroke Scale (NIHSS) score (OR 0.9; 95% CI 0.8 to 0.97; p<0.01) and use of 3 mm Trevo (OR 2.2; 95% CI 1.1 to 4.6; p=0.02) independently associated with first-pass mTICI 2b–3 reperfusion.

Conclusions In the setting of distal arterial occlusions, the 3 mm Trevo may lead to higher rates of first-pass reperfusion than direct 3MAX thromboaspiration. Lower NIHSS was found to be associated with improved reperfusion rates as observed in more proximal lesions. Further studies are warranted.

  • stroke
  • thrombectomy
  • stent

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  • Contributors DCH: Study conception, design of the work, acquisition of data, statistical analysis, interpretation of data, drafting of the manuscript. BE, ARA, JAG, GMR, MRF: Data acquisition, critical revision of manuscript. RN: Design of the work, acquisition of data, interpretation of data, critical revision of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DCH: Consultant for Stryker and Vesalio. RN: Principal Investigator, Stryker Neurovascular (DAWN trial (no compensation), Trevo‑2 trial), Cerenovus/Neuravi (ENDOLOW trial, no compensation); consultant to Stryker Neurovascular; steering committee member, Stryker Neurovascular (no compensation), Medtronic (SWIFT trial, SWIFT Prime trial (no compensation)), Cerenovus/Neuravi (ARISE‑2 trial, no compensation); angiographic core lab, Medtronic (STAR trial); executive committee mem­ber, Penumbra (no compensation); physician advi­sory board, Cerenovus/Neuravi, Phenox, Anaconda, Genentech, Biogen, Prolong Pharmaceuticals, Allm (no compensation), Viz-AI; stock options, Viz-AI.

  • Ethics approval Emory University Institutions Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The unpublished data from this dataset is held by Grady Memorial Hospital/Emory University and DCH/RN. Requests for data sharing would be required to be discussed with them directly.

  • Patient consent for publication Not required.