Initial Experience With the Trevo NXT Stent Retriever

Abstract

Background: The application of a new coating to the delivery wire of the Trevo retriever has the potential to improve its handling. We therefore report our initial experience with this new stent retriever for mechanical thrombectomy of large and medium vessel occlusions.Methods: We pooled data of four high-volume European stroke centers over the time period from October 2020 to February 2021. Patients were included in our study if the Trevo NXT stent retriever was used as a first-line device. Primary endpoints were first-pass near-complete or complete reperfusion, defined as mTICI score of ≥2c. Secondary endpoints were final reperfusion, National Institutes of Health Stroke Scale (NIHSS) at 24 h and discharge, device malfunctions, complications during the procedure, and subjective ratings of the interventionalists regarding device functionality.Results: Eighty patients (39 women, mean age 74 ± 14 years) were eligible for our study. Median NIHSS at admission was 15 (IQR, 8–19), and median Alberta Stroke Program Early CT Score at baseline was 9 (IQR, 8–10). In 74 (93%) patients a primary combined approach was used as first-line technique. First-pass near-complete reperfusion was achieved in 43 (54%) and first-pass complete reperfusion in 34 (43%) patients. Final near-complete reperfusion was achieved in 66 (83%) patients after a median of 1.5 (1–3) passes, while final successful reperfusion was observed in 96% of our cases. We observed no device malfunctions. Median NIHSS at discharge was 2 (IQR, 0–5), and 3 patients (4%) suffered a symptomatic intracranial hemorrhage.Conclusions: Based on our initial data, we conclude that the Trevo NXT is an effective and safe tool for mechanical thrombectomy especially when used for combined approaches.

Contemporary Methods for Detection and Intervention of Distal Medium and Small Vessel Occlusions

“…The authors reported only two cases of vasospasm and no cases of symptomatic intracranial hemorrhage. Despite being originally developed for use in PLVO, this mini stent retriever showed similar or better rates of recanalization in this study when used in M2 occlusions (22/22, 100%) compared with cases of PLVO (M1 or ICA-terminus, 49/52, 94%) and, interestingly, required less passes on average (1.0 passes for DMSVO and 1.5 passes for PLVO) [ 59 ]. Although further multicenter, randomized studies are warranted to further support the efficacy of using mini stent retrievers for DMSVOs, this new generation of mini-stent retrievers appears, in early studies, to be safe and feasible for a variety of vessel sizes due to its adaptable, low-profile design and maneuverability.…”

“…Interestingly, this study used the Tigertriever 13 stent in a wide variety of both anterior and posterior circulation DMSVOs, demonstrating the adaptability as well as the safety and feasibility of using this low-profile stent retriever in the treatment of DMSVO [ 13 ]. Etter et al used the 3 and 4 mm Trevo NXT Provue Retriever (Stryker, Freemont, CA, USA) in 22 patients with M2 occlusion and achieved a 100% final reperfusion rate mTICI ≥ 2b (86% mTICI ≥ 2c, 59% mTICI 3), with an average pass number of 1 [ 59 ]. The authors reported only two cases of vasospasm and no cases of symptomatic intracranial hemorrhage.…”

In Vitro Blood Clot Formation and Dissolution for Testing New Stroke-Treatment Devices

“…Mechanical retrieval, on the other hand, utilizes catheter-based devices to remove the thrombus. Stent retriever devices, such as the Trevo TM and Solitaire TM , are used to “grab” the clot by mechanical interference, allowing the clot to be pulled out along with the catheter [ 15 , 16 ]. Aspiration guide catheters, such as the Penumbra, provide suction to assist in removal [ 2 , 17 , 18 ].…”

Comparing a novel Catfish flow restoration device and the Solitaire stent retriever for thrombectomy revascularisation in emergent largevessel occlusion stroke: a prospective randomised controlled study

“…The subjective experience of interventionalists with the MT device was surveyed using an ordinal 5-point scale, with 1–5 reflecting very easy, easy, neutral, hard and very hard, respectively. 11 …”