Advancing beyond recent randomized controlled trials: Role of Tigertriever13 for distal medium vessel occlusion

Background and purposeTo assess the safety and efficacy of Tigertriever 13 (T13) (one center experience) for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) in patients with primary or secondary distal, medium-size vessel occlusions (DMVOs).MethodsWe performed a retrospective analysis of all consecutive AIS patients who underwent thrombectomy with T13 for DMVO (from 2018 until the present). Patient's characteristics were analyzed as well as procedural complications, angiographic (modified thrombolysis in cerebral infarction [mTICI]) score, and clinical outcomes (modified Rankin Scale [mRS]).ResultsOur cohort included 43 patients. Male predominance was noticed (60.5%), the median age was 71 years (interquartile range [IQR], 65-83), and 37.2% of patients received IV lytics prior to MT. Our cohort was divided into three sub-groups: (1) primary DMVO (17 patients, 39.5%), (2) secondary DMVO following large vessel occlusion (19 patients, 44.18%), and (3) DMVO related to the non-stroke endovascular procedure, such as aneurysm repair and carotid artery stenting (seven patients, 16.2%). Successful recanalization (mTICI 2b-3) was achieved in most of the patients (37/43, 86.04%). None of the patients have experienced symptomatic intracranial hemorrhage (ICH), and seven patients (16.3%) had asymptomatic ICH. Median mRS score was 3 at day 90 (IQR, 2-5), with 17 patients (39.5%) gained favorable outcome (mRS ≤ 2). Mortality was documented among 11.8% in primary DMVO and 10.52% in secondary DMVO.ConclusionsT13 for MT seems to be safe and effective for DMVO. Clinical outcomes and complications were in line with those described among patients with proximal occlusions. Although considered a remote target, it seems to be technically achievable with a reasonable outcome.