Mechanical thrombectomy with the Trevo ProVue device in ischemic stroke patients: does improved visibility translate into a clinical benefit?
OBJECTIVE
To investigate the efficacy and safety of the Trevo ProVue (TPV) stent retriever in stroke patients with large artery occlusions, with particular attention to the full structural radiopacity of the TPV.


METHODS
Case files and images of TPV treatments were reviewed for clinical and technical outcome data, including revascularization rates, device and procedure related complications, and outcome at discharge and after 90 days.


RESULTS
76 patients were treated with TPV. Mean National Institutes of Health Stroke Scale (NIHSS) score was 18 and 68% had additional intravenous thrombolysis. 63 occlusions were in the anterior circulation: 44 M1 (58%), 8 M2 (11%), 8 internal carotid artery-terminus (11%), 2 internal carotid artery- left (3%), 1 A2 (1%), and 13 vertebrobasilar (17%). 58 of 76 (76%) were solely treated with TPV; the remainder were treated with additional stent retrievers. Mean number of passes in TPV only cases was 2.2 (SD 1.2). In rescue cases, 3.2 (SD 2.2) passes were attempted with the TPV followed by 2.6 rescue device passes (SD 2). TPV related adverse events occurred in 4/76 cases (5%) and procedural events in 6/76 cases (8%). Mean procedural duration was 64 min (SD 42). Thrombolysis in Cerebral Infarction (TICI) 2b/3 recanalization was achieved in 69/76 patients (91%), including 50% TICI 3. Of 56 survivors (74%), 37 (49%) showed a favorable outcome at 90 days (Solitaire With the Intention for Thrombectomy trial criteria), statistically associated with age, baseline NIHSS, onset to revascularization time, and TICI 2b-3 reperfusion. TPV radiopacity allowed for visual feedback, changing the methodology of stent retriever use in 44/76 cases (58%).


CONCLUSIONS
Neurothrombectomy with TPV is feasible, effective, and safe. The recanalization rate compares favorably with reported data in the literature. Improved structural radiopacity may facilitate neurothrombectomy or influence the course of action during retrieval.
Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany.
Christoph
C
Kabbasch
Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany.
Anastasios
A
Mpotsaris
Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany.
De-Hua
DH
Chang
Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany.
Sonja
S
Hiß
Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany.
Franziska
F
Dorn
Department of Neuroradiology, University Medical Center Goettingen, Goettingen, Germany.
Daniel
D
Behme
Department of Neurology, University Hospital of Cologne, Cologne, Germany.
Oezguer
O
Onur
Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany.
Thomas
http://orcid.org/0000-0001-5640-7780
T
Liebig
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015427:Reperfusion Injury / Q000628:therapy; D015607:Stents; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
Angiography; Intervention; Stroke; Thrombectomy