Background The optimal interaction between stent struts and thrombus is crucial for successful revascularization in endovascular stroke therapy with stent retrievers. Deploying the stent retriever by actively pushing it into the thrombus increases the radial force with which the stent struts expand into the thrombus.
Objective To examine the active push deployment (APD) technique in an in vitro model and present our clinical experience with this technique.
Methods In an in vitro experiment we investigated the configuration of a Solitaire and a Trevo ProVue device (both 4×20 mm), depending on whether the devices were deployed using the APD technique or simple unsheathing. We retrospectively assessed the effectiveness and safety of this technique by analyzing 130 patients with large vessel occlusions (carotid T or M1 segment of the middle cerebral artery), who received endovascular treatment with a Trevo device (4×20 mm) that was deployed using the APD technique.
Results In vitro experiment: the APD technique improved apposition of the devices to the vessel wall. There was widening of 30% (Trevo) and 19% (Solitaire) at the cost of a shortening of 5% and 4%, respectively, when the devices were deployed in a carotid T model. Clinical study: the revascularization rate (Thrombolysis in Cerebral Infarction ≥2b) with the Trevo device was 90%. There were no retriever-associated dissections or perforations in 278 retrieval maneuvers.
Conclusions The APD technique improves apposition of the tested devices to the vessel wall. The widening effect comes at the cost of minimal shortening of the devices. Our clinical experience shows that using the APD technique to deploy the Trevo device is effective and safe.
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Contributors All authors: conception and design; acquisition of data; analysis and interpretation of data; drafting of the article; critically revision of the article.
Competing interests M-AB: non-financial support from Covidien, Stryker, Terumo/Microvention. MW: grants from Stryker Neurovascular, Siemens Healthcare; personal fees from Stryker Neurovascular, Silkroad Medical, Siemens Healthcare, Bracco; non-financial support from Codman Neurovascular, Covidien, Abbott, St Jude Medical, Phenox, Penumbra, Microvention/Terumo, B Braun, Bayer, Acandis, ab medica.
Ethics approval RWTH Aachen University.
Provenance and peer review Not commissioned; externally peer reviewed.
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