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The Tigertriever 13 for mechanical thrombectomy in distal and medium intracranial vessel occlusions

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

To report our two-center initial experience using the Tigertriever 13 in the treatment of acute stroke of distal, medium vessel occlusions (DMVO).

Methods

We performed a retrospective analysis of all patients treated by mechanical thrombectomy using the Tigertriever 13 device (a manually expandable low profile stent retriever) due to an acute DMVO. Locations included the anterior, middle, and posterior cerebral artery in the A2 and A3, the M3 and M4, and the P2 or P3 segment and the superior cerebellar artery.

Results

Forty-three patients with 45 DMVOs underwent MTE using the Tigertriever 13 with the intention-to-treat approach between May 2019 and December 2020. After a median of two thrombectomy maneuvers, the successful recanalization rate (mTICI 2b-3) was 84.4% (38/45) with a first pass effect of 26.7% (12/45). The rate of symptomatic intracranial hemorrhages (sICH) and subarachnoid hemorrhages (SAH) was 7.0% (3/43) and 14.0% (6/43), respectively. At discharge, 53.5% (23/43) of the patients had a favorable clinical outcome (mRS 0–2).

Conclusion

Mechanical thrombectomy in DMVOs using the Tigertriever 13 leads to high recanalization rates. The incidence of mostly asymptomatic hemorrhagic events appears higher compared to MTE procedures in LVOs. Further studies will help to identify anatomic and clinical criteria to define a guideline for MTE in DMVOs.

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Abbreviations

MTE:

Mechanical thrombectomy

LVO:

Large vessel occlusion

DMVO:

Distal medium vessel occlusion

MCA M2:

M2 segment of the middle cerebral artery

MCA M3:

M3 segment of the middle cerebral artery

MCA M4:

M4 segment of the middle cerebral artery

ACA A1:

A1 segment of the middle cerebral artery

ACA A2:

A2 segment of the middle cerebral artery

ACA A3:

A2 segment of the middle cerebral artery

PCA P1:

P1 segment of the middle cerebral artery

PCA P2:

P2 segment of the middle cerebral artery

PCA P3:

P3 segment of the middle cerebral artery

SCA:

Superior cerebellar artery

ENT:

Embolie in new territory

CT:

Computed tomography

CTA:

Computed tomography angiography

CTP:

Computed tomography perfusion

NIHSS:

National Institute of Health Stroke Scale

mRS:

Modified Rankin scale

TICI:

Thrombolysis in cerebral infarction

ICA:

Internal carotid artery

VA:

Vertebral artery

SAH:

Subarachnoid hemorrhage

ICH:

Intracerebral hemorrhage

sICH:

Symptomatic intracerebral hemorrhage

IVT:

Intravenous therapy

tPA:

Tissue plasminogen activator

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Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, In der Schornau 23-25, 44892, Bochum, Germany

    Sebastian Fischer, Lena Will, Werner Weber & Volker Maus

  2. Institut Für Interventionelle Radiologie Und Neuroradiologie, Neurozentrum Solingen, Radpax St. Lukas Hospital, Solingen, Germany

    Timo Phung & Hannes Nordmeyer

  3. School of Medicine, Department of Health, Witten/Herdecke University, Witten, Germany

    Hannes Nordmeyer

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  1. Sebastian Fischer
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  4. Werner Weber
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Correspondence to Sebastian Fischer.

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Author 1—agreement with Rapid Medical for consulting.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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A separate informed consent from each patient before inclusion in this study was not required due to the retrospective design of the study.

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Fischer, S., Will, L., Phung, T. et al. The Tigertriever 13 for mechanical thrombectomy in distal and medium intracranial vessel occlusions. Neuroradiology 64, 775–783 (2022). https://doi.org/10.1007/s00234-021-02792-x

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  • DOI: https://doi.org/10.1007/s00234-021-02792-x

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