Mechanical Thrombectomy Using the Trevo ProVue in 50 Consecutive Patients with Anterior Circulation Stroke: A Single-Center Experience after Approval of the Stent Retriever in Japan

Abstract

Mechanical thrombectomy using the stent retriever has been proven to be effective for select patients with acute ischemic stroke. We evaluated our early experience using the device after its approval in 2014 in Japan, with a special emphasis on the occlusion site. Fifty consecutive endovascular revascularization procedures for treating anterior acute large vessel occlusion were performed using the Trevo ProVue as the first-line device at our institute between April 2015 and March 2016. Focusing on the involvement of the M1–M2 bifurcation with deployment or retrieval of the stent retriever, we regarded the middle cerebral artery M1 mid-portion as the boundary and divided the cases into proximal (n = 26) and distal (n = 24) groups. We assessed the overall clinical outcome and compared the outcome between the two groups. Among 50 patients (median age, 80 years; National Institutes of Health Stroke Scale score (NIHSS) score, 20), successful (modified Thrombolysis in Cerebral Infarction score (TICI) 2b or 3) or complete revascularization (TICI 3) was achieved in 41 patients (82%; 88% in the proximal group vs 75% in the distal group, P = 0.28) and in 27 patients (54%; 73% vs 33%, P = 0.01), respectively. Symptomatic intracranial hemorrhage occurred in three patients (6%; 4% vs 8%, P = 0.60). A good outcome (mRS score 0 to 2) was obtained in 25 patients at 90 days (50%; 54% vs 46%, P = 0.78). Mechanical thrombectomy using the Trevo ProVue was safe and effective in patients with acute cerebral artery occlusion, especially for proximal occlusions. The efficacy of the procedure for distal occlusions was somewhat inferior to those for proximal occlusions, which might be resolved by next generation devices.

Endovascular Thrombectomy for Distal Occlusion Using a Semi-Deployed Stentriever: Report of 2 Cases and Technical Note

“…The thrombus was successfully removed with one pass and no hemorrhagic complications were encountered in both cases. A similar concept was first described by Imahori et al [7] in 14 cases of M1 or M2 occlusion using larger stent retrievers if the blood clot is short.…”

Endovascular treatment of acute ischaemic stroke in octogenarians and nonagenarians compared with younger patients

“…Successful reperfusion was the most important predictor of favourable clinical outcome after EVT in our analysis, as reported in previous studies. 29,30 Our data suggest that a favourable outcome can be expected after successful reperfusion even in the elderly, and EVT should not be withheld in this population simply because of age.…”

Iatrogenic intracranial vessel dissection during mechanical thrombectomy rescued by emergent stenting: 2 case reports

“…Among these cases, extracranial dissection was more common, whereas intracranial vessel dissection was precisely described in only a small number [11 , 17] . Among approximately 250 cases of mechanical thrombectomy at our institute over the past 5 years, only these 2 patients were definitively diagnosed with iatrogenic intracranial dissection (0.8%) [20] , [21] , [22] , [23] . However, there is a current concern that instances of intracranial dissection may increase because more peripheral lesions are being treated with a variety of interventions other than the simple SR technique.…”

“…Two patients (0.8%), out of approximately 250 cases of mechanical thrombectomy over the past 5 years at our institution, were definitively diagnosed with iatrogenic intracranial dissection caused by the thrombectomy procedure [20] , [21] , [22] , [23] . In this report, we provide the details of these 2 cases of refractory iatrogenic intracranial artery dissection that occurred during mechanical thrombectomy performed with the combined use of an SR and an aspiration catheter.…”