Mechanical Thrombectomy in Acute Terminal Internal Carotid Artery Occlusions Using a Large Manually Expandable Stentretriever (Tiger XL Device): Multicenter Initial Experience

Abstract

Background: The recently introduced Tigertriever XL Device for treatment of cerebral vessel occlusions combines manual adjustability and maximum length in one device. In this study, we report our initial experience with the Tigertriever XL in terminal ICA occlusions. Methods: Retrospective multicenter analysis of acute terminal ICA occlusions treated by mechanical thrombectomy using the Tigertriever XL Device. Results: 23 patients were treated using the Tigetriever XL due to an acute occlusion of the terminal ICA. The overall successful reperfusion rate after a median of two maneuvers using the Tigertriever XL Device was 78.3% (mTICI 2b-3). In 43.5% (10/23) additional smaller devices were applied to treat remaining occlusions in downstream territories, which resulted in a final successful reperfusion rate of 95.7%. Device related complications did not occur. Two symptomatic intracerebral hemorrhages (sICH) were observed. Conclusions: The Tigertriever XL Device might be a helpful tool in the treatment of ICA terminus occlusions with large clot burden resulting in high reperfusion rates. This is mainly related to the manual adjustability of the device combined with the maximum length.

Endovascular Recanalization for Acute Internal Carotid Artery Terminus Occlusion: A Subgroup Analysis From the Direct-MT Trial

“…Recently, a large manually expandable stent retriever achieved 34.8% (8 of 23) of FPE in ICA terminus occlusion with successful recanalization in 95.7% (22 of 23) and mRS 0 to 2 in 26.1% (6 of 23) of patients. 25 FPE, as a modifiable factor, warrants further improvements to achieve better clinical outcomes in thrombectomy for ICA terminus occlusions.…”

“…Collateral flow can modify endovascular treatment efficacy by facilitating thrombus retrieval and lowering the number of device passes. 22 In addition, under different collateral flows, even the association between the clot burden score and functional outcome (17,25) for patients with 90-day mRS = 6 vs 18 (14,22) for patients with 90-day mRS < 6.…”

“…Factors Analysis for Futile Recanalization a Alberta Stroke Program Early Computed Tomography score; eTICI, extended thrombolysis in cerebral ischemia; mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; OR, odds ratio. Futile recanalization indicates 90-day mRS > 2 despite eTICI ≥ 2b.Baseline NIHSS (median [IQR]) referred to 20(16,25) for patients with final eTICI ≥ 2b and 90-day mRS > 2 vs 16(12,20) for patients with final eTICI ≥ 2b and 90-day mRS 0-2.…”

Mechanical thrombectomy of large vessel occlusion using adjustable vs. self-expanding stent-retriever—Comparison of Tigertriever device with stent-like stent-retrievers: A propensity score analysis

“…Tigertriver XL is the newest and the largest device in the portfolio. It is designed to remove clots from arteries up to 9 mm in diameter (mostly from an internal carotid artery) (9). Tigertriever has had a CE mark since 2016 and has shown promising results regarding its efficiency and safety, mostly in singlecenter studies (7,10).…”

“…Tigertriver XL is the newest and the largest device in the portfolio. It is designed to remove clots from arteries up to 9 mm in diameter (mostly from an internal carotid artery) ( 9 ).…”