Trevo NXT® Retriever
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Early data confirm Trevo NXT Retriever as an effective tool for mechanical thrombectomy
the ICA-T and one for the M1/M2) and the groin to reperfusion time (median 51 minutes for ICA-T vs. 34/35 minutes for M1/M2) were higher for ICA-T occlusions. Discussing the findings, Psychogios et al highlight that the rate of first-pass complete or near complete reperfusion was achieved in 54% of cases, comparing favourably to previously published data of the predecessor device, while final mTICI ≥2c was achieved in 83% of cases and final complete Initial data pooled from four high-volume European stroke centres indicate reperfusion (mTICI 3) in 56% of the cases. that Stryker's Trevo NXT Retriever is an effective and safe tool for mechanical Regarding the technical aspects of using the thrombectomy, especially when used for combined approaches. This was Trevo NXT Retriever as a first-line device, the finding of Manina Etter, Alex Brehm and Marios-Nikos Psychogios they write that advancing the stent retriever (Department of Neuroradiology, University Hospital Basel, Basel, Switzerland) within the microcatheter was “easy” in the alongside researchers from University Hospital Heidelberg (Heidelberg, Germany), majority of cases and target placement was Hospital Clínico San Carlos, (Madrid, Spain), Careggi University Hospital, achieved in all cases. “Our impression after (Florence, Italy) and University Hospital RWTH Aachen, (Aachen, Germany), who using the 4mm Trevo NXT with 0.021” reported initial experience with the device for mechanical thrombectomy of largemicrocatheters is that the pushability of the and medium vessel occlusions in the journal Frontiers in Neurology.1 stent retriever is given even in tortuous proximal vessels. While treating distal occlusions with the 3mm MECHANICAL THROMBECTOMY range [IQR] 8–19) and median Trevo NXT, pushing the device Trevo NXT is the standard of care for ischaemic stroke Alberta Stroke Program Early through a 0.017” microcatheter Retriever caused by large vessel occlusion (LVO). CT Score (ASPECTS) on initial was feasible,” they write. “In our The main techniques include use of a stent imaging was 9 (IQR 8–10). subjective opinion, pushing the retriever and withdrawal of the device with or First-pass or near-complete new 3mm device through a 0.017” without flow arrest by a balloonreperfusion was achieved in microcatheter was easier compared to guide catheter; direct aspiration 43 (54%) patients, with complete previous Trevo generations, although we did technique using a large-bore reperfusion (mTICI 3) seen in 34 not compare the two devices in this study.” aspiration catheter (ADAPT), (43%). Final complete, or nearAs for the retrieval of the device into the placed at the face of the clot; or, complete reperfusion (mTICI ≥2c) aspiration catheter or balloon-guide catheter, primary combined approaches using was observed in 66 patients (83%) the authors received positive feedback. These a stent retriever and an aspiration and complete reperfusion (mTICI 3) findings are consistent with the development catheter intracranially, with in 45 (56%) patients, after a median of a hydrophilic coated polymer jacket, Marios-Nikos additional extracranial aspiration of 1.5 passes (IQR 1–3). The designed to enable smoother and easier Psychogios through the guide catheter. study’s authors note that the rate delivery and improved retraction. The authors Stryker’s Trevo stent retriever is a wellof successful reperfusion was 64% after one write that the device can be regarded as safe, established mechanical thrombectomy device, pass, and 96% at the end of the procedure. with complication rates comparable to those with earlier iterations of the device having A total of 158 passes were performed, and of the literature. In sum, the findings lead the been the most frequently used devices in no device malfunctions were observed. Four authors to conclude that, based on initial data, the MR CLEAN trial,2 and the only stent complications were seen; two subarachnoid the Trevo NXT Retriever is an effective and retriever used in the interventional arm of haemorrhages, and two vasospasms. safe tool for mechanical thrombectomy— the DAWN randomised trial. Psychogios A subgroup analysis of the angiographic especially when using combined approaches. et al assessed the new-generation Trevo results after stratification by occlusion site NXT, Retriever focusing on the efficacy and indicated higher first-pass complete or nearReferences: peri-interventional safety of the device, from complete reperfusion results in the M1 and 1: Etter M, Möhlenbruch M, Weyland C, et al. Initial experience with the Trevo NXT stent retriever. Front Neurol. Forthcoming 2021. October 2020 to February 2021. M2 segments compared to the internal carotid 2: Berkhemer O, Fransen P, Beumer D, et al. A Randomized Trial of The study’s primary endpoint was first-pass artery terminus (ICA-T; 53%/46% vs. 29%), Intraarterial Treatment for Acute Ischemic Stroke. N Engl J Med. 2015;372.(1):11–20. complete or near-complete reperfusion, while the number of passes (median three for defined as a modified thrombolysis in cerebral infarction (mTICI) score ≥2c. Secondary Per Pass Reperfusion Results1 endpoints included final reperfusion, National Institutes of Health Stroke Scale (NIHSS) at Pass # 1 2 3 4 5 6 24 hours and discharge. Interventionalists Number of patients 80 34 20 14 8 5 gave subjective ratings based upon their experience of delivering and retracting the mTICI <2b, n (%) 29 (36%) 18 (53%) 12 (60%) 8 (54%) 5 (63%) 3 (60%) catheter compared to previous generations. mTICI ≥2b, n (%) 51 (64%) 16 (47%) 8 (40%) 6 (46%) 3 (37%) 2 (40%) In total, 80 patients were enrolled in the mTICI ≥2c, n (%) 43 (54%) 12 (35%) 5 (25%) 3 (23%) 1 (12%) 1 (20%) study, with a mean age of 74±14 years, and 39 patients (49%) were female. The median mTICI 3, n (%) 34 (43%) 7 (21%) 2 (10%) 2 (15%) 0 (0%) 0 (0%) NIHSS at admission was 15 (interquartile September 2021
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