Introduction Medium vessel occlusions in stroke patients account for 25−40% of acute ischemic strokes, and recanalization with endovascular thrombectomy has been shown to be of benefit in select patients. Advancements in mechanical thrombectomy devices with structural features that aid navigation through narrower medium/distal vessel vasculature offer promise for improving success in medium vessel occlusion thrombectomy. In this study, we aim to evaluate the safety and efficacy of using the 3mm Trevo NXT stent retriever (Stryker, Kalamazoo, MI) for mechanical thrombectomy in stroke patients with acute ischemic stroke caused by medium vessel occlusions.

Materials and Methods Acute ischemic stroke patients within the past 5 years (2018−2022) who underwent mechanical thrombectomy for medium vessel occlusions (i.e., M2−M4, ACA, PCA) with a 3mm Trevo NXT stent retriever were retrospectively reviewed from a single-center registry. Primary efficacy outcomes included successful recanalization rate using Trevo NXT (modified thrombolysis in cerebral infarction [mTICI] >=2B) and groin-to-revascularization time. The primary safety outcome was rate of Trevo-associated procedural complications. The primary clinical outcome examined was National Institutes of Health Stroke Scale (NIHSS) at 24 hours after intervention.

Results Of 81 patients with acute ischemic stroke from medium vessel occlusions treated with thrombectomy, 44 patients (52.2% female, mean age of 71.1 years, median initial NIHSS of 15 [IQR 8−22.8] at presentation) underwent thrombectomy with 3mm Trevo NXT stent retrievers. Of 106 total thrombectomy passes, 51 passes involved use of 3mm Trevo, which comprised 15.7% M1, 39.2% M2, 29.4% M3, 9.8% ACA, and 5.9% PCA occlusions. Stent retriever-assisted aspiration was performed in 82.4%. 3mm Trevo stent retrievers were used in the first pass in 56.9% of individuals, with 72.4% achieving successful recanalization. 3mm Trevo stent retrievers were used as ‘rescue’ after initial revascularization failure in 43.1% of individuals. Successful recanalization following use of 3mm Trevo as a rescue intervention was achieved in 60.0% of passes. Of cases that failed 3mm Trevo rescue, 66.67% never achieved successful revascularization during the procedure. Acute complications attributed to 3mm Trevo stent retriever usage were reported in 2.4% of cases (1 case of self-resolving contrast extravasation and 1 case of vasospasm resolved with verapamil). Median NIHSS at 24 hours after intervention was 12 (IQR 4−20.8).

Conclusion Use of 3mm Trevo NXT stent retriever in medium vessel occlusion for first line and rescue thrombectomy in our single center experience demonstrated an adequate safety and efficacy profile, thus endorsing its use in mechanical thrombectomy applications beyond large vessel occlusion cases. Future multicenter studies will build upon this initial experience to further characterize the utility of novel stent retrievers in medium vessel occlusions.

Disclosures C. Zhao: None. M. Koneru: None. J. Siegler: None. N. Vigilante: None. J. Khalife: None. D. Tonetti: None. H. Shaikh: None.