Mechanical Thrombectomy in Acute Ischemic Stroke Using a Manually Expandable Stent Retriever (Tigertriever)

Preliminary Single Center Experience

Abstract

Objective

The aim of this study was to evaluate the safety and efficacy of a manually expandable stent retriever (Tigertriever, Rapid Medical, Yoqneam, Israel) in the treatment of acute ischemic stroke caused by intracranial large vessel occlusions (LVO).

Methods

We performed a single center retrospective analysis of all patients treated by mechanical thrombectomy due to LVO using the Tigertriever. The angiographic and clinical success was evaluated by the modified thrombolysis in cerebral infarction score (mTICI) and the modified Rankin score (mRS).

Results

A total of 68 acute intracranial arterial occlusions in 61 patients (42 female, median age 77 years, range 43–92 years) were treated by mechanical thrombectomy using the Tigertriever. The overall successful reperfusion rate (mTICI 2b-3) was 85.3% (58/68 occlusions) with a first pass effect (mTICI 3) of 23.5% (16/68 occlusions). In 57 of the 68 occlusions the Tigertriever was used on an intention to treat approach with a success rate of 86.0% and in the 11 remaining occlusions where the Tigertriever was used as a bail-out device the success rate was 81.9%. In seven patients a mild subarachnoid hemorrhage occurred (11.5%) and one symptomatic intracerebral hemorrhage was observed (1.6%). At discharge 39.3% of the patients (24/61) had a favorable outcome (mRS 0–2).

Conclusion

The Tigertriever offers a safe and effective treatment option in ischemic stroke due to LVOs with reperfusion rates and a safety profile similar to alternative devices. The Tigertriever is a promising bail-out tool in complex cases. Its role as a first line device has to be evaluated in further prospective studies.

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Abbreviations

CT:

Computed tomography

ENT:

Embolism in new territory

F:

French

ICA:

Internal carotid artery

IVT:

Intravenous thrombolysis

LVO:

Large vessel occlusion

mTICI:

Modified thrombolysis in cerebral infarction

NIHSS:

National Institutes of Health Stroke Scale

PTA:

Percutaneous transluminal angioplasty

SAH:

Subarachnoid hemorrhage

sICH:

Symptomatic intracerebral hemorrhage

VA:

Vertebral artery

References

  1. 1.

    Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20.

    Article  Google Scholar 

  2. 2.

    Bhogal P, Andersson T, Maus V, Mpotsaris A, Yeo L. Mechanical thrombectomy. A brief review of a revolutionary new treatment for thromboembolic stroke. Clin Neuroradiol. 2018;28:313–26.

    Article  Google Scholar 

  3. 3.

    Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischemic stroke: a meta-analysis of individual patient data from five randomized trials. Lancet. 2016;387:1723–31.

    Article  Google Scholar 

  4. 4.

    Campbell BCV, Donnan GA, Lees KR, Hacke W, Khatri P, Hill MD, et al. Endovascular stent thrombectomy: the new standard of care for large vessel ischemic stroke. Lancet Neurol. 2015;14:846–54.

    Article  Google Scholar 

  5. 5.

    Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:3020–35.

    Article  Google Scholar 

  6. 6.

    Aguilar Perez M, Miloslavski E, Fischer S, Bäzner HJ, Henkes H. Intracranial thrombectomy using the Solitaire stent: a historical vignette. J Neurointerv Surg. 2012;4:e32.

    Article  Google Scholar 

  7. 7.

    Zaidat OO, Castonguay AC, Nogueira RG, Haussen DC, English JD, Satti SR, et al. TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry. J Neurointerv Surg. 2018;10:516–24.

    Article  Google Scholar 

  8. 8.

    Maus V, Henkel S, Riabikin A, Riedel C, Behme D, Tsogkas I, et al. The SAVE Technique: large-scale experience for treatment of intracranial large vessel occlusions. Clin Neuroradiol. 2019;29:669–76.

    Article  Google Scholar 

  9. 9.

    Nikoubashman O, Wischer D, Hennemann HM, Sandmann J, Sichtermann T, Müschenich FS, et al. Balloon-guide catheters are needed for effective flow reversal during mechanical thrombectomy. AJNR Am J Neuroradiol. 2018;39:2077–81.

    CAS  Article  Google Scholar 

  10. 10.

    Fischer S, Weber A, Carolus A, Drescher F, Götz F, Weber W. Coiling of wide-necked carotid artery aneurysms assisted by a temporary bridging device (Comaneci): preliminary experience. J Neurointerv Surg. 2017;9:1039–97.

    CAS  Article  Google Scholar 

  11. 11.

    Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke. Stroke. 2013;44:2650–63.

    Article  Google Scholar 

  12. 12.

    Maus V, Styczen H, Liman J, Maier I, Brehm A, Tsogkas I, et al. Intracranial mechanical thrombectomy of large vessel occlusions in the posterior circulation using SAVE. BMC Neurol. 2019;19:197.

    Article  Google Scholar 

  13. 13.

    Sheen JJ, Kim YW. Paradigm shift in intra-arteriel mechanical thrombectomy for acute ischemic stroke: a review of randomized controlled trials after 2015. J Korean Neurosurg Soc. 2020. https://doi.org/10.3340/jkns.2019.0151.

    Article  PubMed  Google Scholar 

  14. 14.

    Haussen DC, Rebello LC, Nogueira RG. Optimizing clot retrieval in acute stroke: the push ant fluff technique for closed cell stenttrievers. Stroke. 2015;46:2838–42.

    CAS  Article  Google Scholar 

  15. 15.

    Wenger KJ, Nagl F, Wagner M, Berkefeld J. Improvement of stent retriever design and efficacy of mechanical thrombectomy in a flow model. Cardiovasc Intervent Radiol. 2013;36:192–7.

    Article  Google Scholar 

  16. 16.

    Machi P, Jourdan F, Ambard D, Reynaud C, Lobotesis K, Sanchez M, et al. Experimental evaluation of stent retrievers’ mechanical properties and effectiveness. J Neurointerv Surg. 2017;9:257–63.

    Article  Google Scholar 

  17. 17.

    Kara B, Selcuk HH, Erbahceci Salik A, Zalov H, Yildiz O, Gul G, et al. Single-center experience with the Tigertriever device for the recanalization of large vessel occlusions in acute ischemic stroke. J Neurointerv Surg. 2019;11:455–9.

    Article  Google Scholar 

  18. 18.

    Kara B, Selcuk HH, Yildiz O, Cetinkaya D. Revascularization of acute basilar artery occlusion using the Tigertriever adjustable clot retriever. Clin Neuroradiol. 2017;27:241–3.

    Article  Google Scholar 

  19. 19.

    Maekawa K, Shibata M, Nakajima H, Mizutani A, Kitano Y, Seguchi M, et al. Erythrocyte-rich thrombus is associated with reduced number of maneuvers and procedure time in patients with acute ischemic stroke undergoing mechanical thrombectomy. Cerebrovasc Dis Extra. 2018;8:39–49.

    Article  Google Scholar 

  20. 20.

    Schwaiger BJ, Kober F, Gersing AS, Kleine JF, Wunderlich S, Zimmer C, et al. The pREset stent retriever for endovascular treatment of stroke caused by MCA occlusion: safety and clinical outcome. Clin Neuroradiol. 2016;26:47–55.

    CAS  Article  Google Scholar 

  21. 21.

    Yoon W, Jung MY, Jung SH, Park MS, Kim JT, Kang HK. Subarachnoid hemorrhage on a multimodal approach heavily weighted toward mechanical thrombectomy with Solitaire stent in acute stroke. Stroke. 2013;44:414–9.

    Article  Google Scholar 

  22. 22.

    Balami JS, White PM, McMeekin PJ, Ford GA, Buchan AM. Complications of endovascular treatment for acute ischemic stroke: prevention and management. Int J Stroke. 2018;13:348–61.

    Article  Google Scholar 

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Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors

Author information

Affiliations

Authors

Contributions

Lena Will: data acquisition, analysis and interpretation, writing of the manuscript. Volker Maus: critical review of the work. Cristoph Maurer: critical review of the work. Anushe Weber: critical review of the work. Werner Weber: critical review of the work. Sebastian Fischer: conception and design of the study, data acquisition, analysis and interpretation, writing of the manuscript, final approval of the manuscript

Corresponding author

Correspondence to S. Fischer.

Ethics declarations

Conflict of interest

S. Fischer: support for travel to meetings. L. Will, V. Maus, C. Maurer, A. Weber and W. Weber declare that they have no competing interests.

Additional information

Data and material are available on reasonable request from the corresponding author.

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Will, L., Maus, V., Maurer, C. et al. Mechanical Thrombectomy in Acute Ischemic Stroke Using a Manually Expandable Stent Retriever (Tigertriever). Clin Neuroradiol (2020). https://doi.org/10.1007/s00062-020-00919-w

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Keywords

  • Stent retriever
  • Tigertriever
  • Ischemic stroke
  • Large vessel occlusion
  • Mechanical thrombectomy