Trevo xp

Additional IA-Tx was attempted in 133 out of the 264 patients, who were not recanalized after IV-tPA treatment (Table 4). Angiograms (Axium Aristos plus; Siemens Medical Systems) were obtained using standard techniques. Once an occlusion was noted on angiography, the diagnostic catheter was exchanged for a 7-French guiding catheter (Guider Softip XF; Boston Scientific, Marlborough, MA, USA) or a balloon embolic protection device (Cello; Covidien, Irvine, CA, USA), which was placed into the internal cerebral artery. The IA-Tx was performed using stent retriever, and either Solitaire AB (EV3, Plymouth, MN, USA) or Trevo XP (Neurovascular; Stryker, Fremont, CA, USA) was selected according to the neurointerventionist’s preference.

In all patients, treatment was started via the transfemoral approach and a 9 Fr balloon guiding catheter was guided into the affected-side cervical ICA. When the transfemoral approach was difficult, it was switched to the right brachial artery-mediated approach. For MT, a Penumbra aspiration catheter (Medicos Hirata, Osaka, Japan) and a Penumbra MAX pump (Medicos Hirata) were used. A direct aspiration first-pass technique (ADAPT)⁴⁾ (link) was selected as a first-choice procedure, and a large-diameter catheter that was considered to be satisfactory for guiding by surgeons was adopted in accordance with the site of occlusion. When a thrombus aspiration catheter did not reach the site of occlusion or when ADAPT did not lead to effective recanalization, MT was performed using a combination technique with different stent retrievers (Solitaire; Medtronic, Minneapolis, MN, USA), Trevo XP (Stryker, Kalamazoo, MI, USA).⁵ (link)^,6) (link)

A neurointerventionalist (C.J.) performed intraarterial treatment (IAT) of all the cases on a biplane angiography machine (Integris Allura, Philips, the Netherlands). We used a 9 French balloon guiding catheter. In case of a tortuous cervical ICA, a second guiding catheter was used for the coaxial system. The primary device for IAT was a stent retriever (Solitaire FR; Covidien, Irvine, California; Trevo-XP; Stryker, Kalamazoo, MI, USA). Mechanical aspiration device, thrombolytics, or permanent stenting were also used at the discretion of operator. The reperfusion grading was measured by using modified treatment in cerebral infarction before and after IAT [13 (link)].