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Abstract
Introduction The Tigertriver allows the operator to control the radial expansion inside the target vessel. The increased radial force of Tigertriever may provide a more effective thrombectomy in patients with acute ischemic stroke (AIS) due to intracranial atherosclerotic disease (ICAD). We analyzed data from the TIGER trial1 to determine the safety and effectiveness of Tigertriever in patients with ICAD.
Methods Computed tomography angiography, and digital subtraction angiography of patients enrolled in the TIGER trial who had underlying ICAD were analyzed by a blinded core laboratory. Underlying ICAD at the large vessel occlusion was adjudicated by two independent investigators. In case of discrepancy, a third senior investigator served as adjudicator. Successful reperfusion was defined as TICI 2b-3 within three passes (figure 1). Only patients who did not require rescue therapy with other devices were included in the analysis to decrease cofounders.
Results One-hundred sixty patients who were included in the TIGER trial were analyzed. Twenty percent (32/160) of patients were determined to have underlying ICAD that may have contributed to the occlusion due to stenosis or was the primary etiology for the large vessel occlusion. Twenty-three (23/32, 72%) patients with ICAD achieved successful reperfusion within 3 passes; the rest required rescue treatment with ancillary devices. Baseline NIHSS score was 16.5 (IQR=7) and median baseline ASPECT score was 9 (IQR=1). Tigetriever had a higher successful reperfusion rate within the first 3 passes (72%) compared to other studies with other stentrievers (63%-65). An increase in the proximal diameter of the occluded vessel was seen after thrombectomy (1.55 ± 0.74 versus 1.86 ± 0.7, p < 0.001). No symptomatic intracranial hemorrhages were observed while asymptomatic intracranial hemorrhage at 24 hours occurred in 17.4% (4/23) of patients. No procedural complications were reported. The NIHSS at 24-hours was 7.95 ± 7.12, and mortality rate for any cause at 3 months was 21.74% (5/23). At three months, 68% (14/23) of patients achieved a mRS score of < 2, compared to historical controls with other stentrievers (42.4% (15/36); 42% (10/24).
Conclusion Tigertriever exerts a higher radial force that can be manually tailored to achieve better recanalization in patients with LVO due to ICAD.
Reference
Gupta R, Saver JL, Levy E, et al. New class of radially adjustable stentrievers for acute ischemic stroke: primary results of the multicenter TIGER trial. Stroke. May 2021;52(5):1534-1544. doi:10.1161/strokeaha.121.034436
(A) A right Ml occlusion due to underlying ICAD (arrowhead). (B) The Tigertriever is deployed across the stenosis. The device ‘massages’ the thrombus and exerts an increased radial force in stenotic lesions due to ICAD (arrowhead). (C) Recanalization with mild residual stenosis (arrowhead)
Disclosures D. Ojeda: None. S. Sanchez: None. J. Miller: None. M. Almajali: None. P. Koul: None. L. Noboa: None. M. Ghannam: None. E. Samaniego: None.