title: Treatment protocol based on assessment of clot quality during endovascular thrombectomy for acute ischemic stroke using the Trevo stent retriever.
abstract: The optional endovascular approach for acute ischemic stroke is unclear. The Trevo stent retriever can be used as first-line treatment for fast mechanical recanalization. The authors developed a treatment protocol for acute ischemic stroke based on the assessment of clot quality during clot removal with the Trevo. This prospective single-center study included all patients admitted for acute ischemic stroke between July 2014 and February 2015, who underwent emergency endovascular treatment. According to the protocol, the Trevo was used for first-line treatment. Immediately after the Trevo was deployed, the stent delivery wire was pushed to open the stent by force (ACAPT technique). Clot quality was assessed on the basis of the perfusion status after deployment of the Trevo; continued occlusion or immediate reopening either reoccluded or maintained after the stent retriever had been in place for 5 min. If there was no obvious clot removal after the first pass with the Trevo, according to the quality of the clot, either a second pass was performed or another endovascular device was selected. Twelve consecutive patients with acute major cerebral artery occlusion were analyzed. Thrombolysis in cerebral infarction score 2b and 3 was achieved in 11 patients (91.7%) and 9 (75%) had a good clinical outcome after 90 days based on a modified Rankin scale score ≤ 2. Symptomatic intracranial hemorrhage occurred in 1 patient (8.3%). The overall mortality rate was 8.3%. Endovascular thrombectomy using the Trevo stent retriever for first-line treatment is feasible and effective.
authors: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors: Kojiro
authors: K
authors: Ishikawa
authors: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors: Tomotaka
authors: T
authors: Ohshima
authors: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors: Masahiro
authors: M
authors: Nishihori
authors: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors: Tasuku
authors: T
authors: Imai
authors: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors: Shunsaku
authors: S
authors: Goto
authors: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors: Taiki
authors: T
authors: Yamamoto
authors: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors: Toshihisa
authors: T
authors: Nishizawa
authors: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors: Shinji
authors: S
authors: Shimato
authors: Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
authors: Kyozo
authors: K
authors: Kato
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015607:Stents; D020521:Stroke; D017131:Thrombectomy; D016896:Treatment Outcome
keywords: acute ischemic stroke; endovascular clot retrieval; thrombus