Single center experience using 3 mm trevo stent retrievers in medium vessel occlusion thrombectomy

Background: Endovascular mechanical thrombectomy has been shown to benefit select patients with acute ischemic stroke caused by medium vessel occlusion, aided by recent advancements in endovascular mechanical thrombectomy devices that facilitate navigation through narrower vasculature. In this study, we aim to evaluate the safety and efficacy of using the 3 mm Trevo NXT stent retriever (Stryker, Kalamazoo, MI) for endovascular mechanical thrombectomy in patients with acute ischemic stroke caused by medium vessel occlusion.

Methods: From our single-center registry, we performed a retrospective review of all acute ischemic stroke patients from 2018 to 2022 who underwent endovascular mechanical thrombectomy for medium vessel occlusion with a 3 mm Trevo NXT. We examined efficacy outcomes (modified thrombolysis in cerebral infarction and puncture-to-revascularization time), clinical outcomes (National Institutes of Health Stroke Scale), and procedural complication rate.

Results: Between 2018 and 2022, 44 patients (52.2% female, mean age 71.1 years, median National Institutes of Health Stroke Scale of 15 [8-22.8]) met our inclusion criteria. The 3 mm Trevo NXT was used in the first pass in 56.9% of individuals, with 72.4% achieving successful recanalization (modified thrombolysis in cerebral infarction ≥ 2B). The 3 mm Trevo NXT was used as "rescue" after initial revascularization failure in 43.1% of individuals, achieving successful recanalization in 60.0% of passes. Acute complications were reported in 2.4% of cases. Median National Institutes of Health Stroke Scale at 24 h after intervention was 12 (4-20.8).

Conclusions: Our results suggest that endovascular mechanical thrombectomy using the 3 mm Trevo NXT is a safe and effective treatment option for medium vessel occlusion. The utility of novel stent retrievers in the treatment of medium vessel occlusion should be further explored in future multicenter studies.