EVT procedures were carried out by 2 of a pool of 3 radiologists with 5 to 15 years of experience in interventional neuroradiology on an Allura Xper FD 20 X-ray system (Philips Healthcare, Best, Netherlands). All patients were treated according to the guidelines: using a stent retriever device, such as Trevo (Stryker Neurovascular, Mountain View, CA) or Solitaire FR (ev3, Irvine, CA) or Aperio (acandis, Pforzheim, Germany). Alternatively, an aspiration catheter, such as ACE (Penumbra, Alameda, CA) or AXS Catalyst 6 (Stryker Neurovascular, Mountain View, CA), if aspiration was unsuccessful followed by stent retriever device. NCCT examinations were performed on a LightSpeed 16 scanner system (GE, General Electric Company, Boston, MA) with an axial 5-mm section thickness. NCCT scans of the brain were taken within 0.5 hours after EVT in all patients. We guided the time of started anticoagulants by imaging and clinical symptoms at 24 hours after thrombectomy.
Trevo
Manufactured by Stryker
Sourced in United States
The Trevo is a comprehensive lab equipment product designed to assist in various scientific and research applications. It serves as a versatile tool, providing essential functionalities required for laboratory operations. The product's core function is to facilitate efficient and reliable data collection, processing, and analysis while adhering to industry standards and safety protocols.
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Lab products found in correlation
Solitaire ab fr, by Medtronic (4 mentions)
Solitaire fr, by Medtronic (2 mentions)
Wallstent, by Boston Scientific (2 mentions)
Axs catalyst 6, by Stryker (1 mentions)
Actilyse, by Boehringer Ingelheim (1 mentions)
Artis q, by Siemens (1 mentions)
Wingspan, by Stryker (1 mentions)
Solitaire ab, by Medtronic (1 mentions)
Microcentrifuge tube, by Eppendorf (1 mentions)
21 protocols using trevo
1
Endovascular Thrombectomy Procedures and Imaging Protocols
2
Thrombectomy Techniques for Acute Stroke
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In this study, the femoral artery is recommended as the site for arterial puncture. The use of a guiding catheter, long sheath or balloon guiding catheter is also recommended during the procedure. Stent-retriever (Solitaire (Medtronic, USA), Trevo (Stryker, USA), EMBOTRAP (Johnson & Johnson, USA), Captor (HeartCare, China) and other stent-retriever systems) and contact aspiration (Penumbra (Penumbra, USA), Afentta (HeMo, China) and other aspiration systems) are recommended as the first choice for thrombectomy. All thrombectomy devices should be performed in compliance with the intended use and operating instructions, and approved by the National Medical Products Administration of China. Multiple thrombectomy techniques, such as stent-retriever plus aspiration (Solumbra), BAlloon guide with large bore Distal access catheter with Dual Aspiration with Stent-retriever as Standard approach, double stent-retrievers, etc, are allowed in this study. The treating team has the autonomy to determine the specific approach for thrombectomy in each patient based on their clinical expertise and judgement.
3
Endovascular Stroke Treatment Protocol
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The decision for EST was made by consensus between the neurologist and neurointerventionalist after initial stroke imaging with CT or MRI. Intravenous thrombolysis was administered according to national and international guidelines. The choice of the sedation mode in the complete study cohort was made according to the patient's compliance, severity of the stroke syndrome, and level of consciousness. In the standard approach for EST, a transfemoral access is performed, followed by placing a guide catheter in the subclavian artery (7F/80 cm Flexor Shuttle, Cook Medical, Bloomington, IN, USA). Subsequently, a distal access catheter is introduced to the vertebral artery. The material mostly used in this cohort is a 5F-Neuron intermediate catheter (2013–2014; Penumbra, Alameda, USA) or a 5F/6F-Sofia intermediate catheter (2013 until today; Microvention, Aliso Viejo, USA). All modern stent-retriever models are available in our facility with Solitaire (Medtronic), Trevo (Stryker, Kalamazoo, USA), and pREset (Phenox, Bochum, Germany) used most commonly for the posterior circulation. The first-line approach (performing contact aspiration or stent-retriever-thrombectomy in combination with continuous distal aspiration using a distal aspiration catheter) as well as the choice of material used for EST was at the discretion of the treating neurointerventionalist.
4
Acute Ischemic Stroke Endovascular Therapy
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EVT was performed by experienced neuro-interventionists using aspiration thrombectomy (Penumbra [Alameda, CA, USA]), stent retrievers [Solitaire (Medtronic, Irvine, CA, USA) or Trevo (Stryker, Fremont, CA, USA)], or the combination of both techniques. Intravenous thrombolysis was performed within 4.5 h after the onset of symptoms. Rescue therapies such as intracranial angioplasty, intra-atrial thrombolysis, stent implementation, or tirofiban administration should be considered when the reperfusion of the target artery fails.
5
Endovascular Thrombectomy Techniques
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The type of EVT procedure was selected at the discretion of the treating physician. The direct aspiration method and stent retrieval were routinely used. The direct aspiration method refers to a forced arterial suction thrombectomy that uses the Penumbra system (Penumbra Inc., Alameda, CA, USA) [20 (link),21 (link)]. Stent retrieval refers to clot removal by capturing and removing the thrombus with a stent retriever such as the Solitaire AB/FR (Medtronic, Irvine, CA, USA) or Trevo (Stryker, Kalamazoo, MI, USA) [22 (link)-24 (link)]. Balloon guide catheters, adjuvant lytic infusion, intracranial or extracranial angioplasty, and/or stenting were implemented as needed.
6
Endovascular Therapy for Acute Stroke
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Patients were generally eligible for endovascular therapy during the study period if they met the following inclusion criteria:
Nearly half of the patients were transferred from remote hospitals (drip-and-ship, n=50%, n=46). In cases of transfer from another hospital, usually, no additional CT imaging was performed before the thrombectomy procedure. Patients received intravenous r-tPA bridging in the absence of contraindication (70.7%, n=65). Patients were treated under conscious sedation or general anesthesia using transfemoral access and standard tri-axial approach with a distal aspiration catheter as described before.19 (link) One patient was treated with a first-generation Penumbra Aspiration System (The Penumbra System, Penumbra, Alameda, CA). In 2 patients, spontaneous reperfusion occurred and in 3 patients, intracranial access could not be established owing to difficult supraaortic vessel configuration/elongation. All other patients were treated with second-generation devices, mostly stent-retrievers (n=76, Solitaire AB, eV3, Irvine, CA Solitaire, Medtronic, Trevo, Stryker, pRESET thrombectomy device, Phenox), large bore aspiration catheters (n=5, eg, 5MAX, Penumbra) or a combination thereof (n=5). In 2 patients, additional intraarterial tPA was infused as rescue therapy.
Nearly half of the patients were transferred from remote hospitals (drip-and-ship, n=50%, n=46). In cases of transfer from another hospital, usually, no additional CT imaging was performed before the thrombectomy procedure. Patients received intravenous r-tPA bridging in the absence of contraindication (70.7%, n=65). Patients were treated under conscious sedation or general anesthesia using transfemoral access and standard tri-axial approach with a distal aspiration catheter as described before.19 (link) One patient was treated with a first-generation Penumbra Aspiration System (The Penumbra System, Penumbra, Alameda, CA). In 2 patients, spontaneous reperfusion occurred and in 3 patients, intracranial access could not be established owing to difficult supraaortic vessel configuration/elongation. All other patients were treated with second-generation devices, mostly stent-retrievers (n=76, Solitaire AB, eV3, Irvine, CA Solitaire, Medtronic, Trevo, Stryker, pRESET thrombectomy device, Phenox), large bore aspiration catheters (n=5, eg, 5MAX, Penumbra) or a combination thereof (n=5). In 2 patients, additional intraarterial tPA was infused as rescue therapy.
7
Mechanical Thrombectomy under Conscious Sedation
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All MT procedures were performed under conscious sedation. All procedures except one were performed with a balloon guide catheter. In 96% of cases, a stent retriever was used (Trevo®, Stryker, Salt Lake City, USA or EmbotrapII®, Neuravi, Galway, Ireland). An intermediate catheter was used for distal aspiration in 59% of cases in conjunction with stent retriever thrombectomy. IVT bolus of recombinant tissue plasminogen activator (rt-PA, Actilyse® 0.9 mg/kg, Boehringer-Ingelheim, Ingelheim, Germany) was administered after NCCT followed by infusion according to international guidelines.
8
Endovascular Thrombectomy Techniques in Stroke
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Endovascular devices were selected at the discretion of neurointerventionists based on consensus within each stroke team. Contact aspiration and stent retrieval were routinely used as a frontline method. Contact aspiration is a method of a forced arterial suction thrombectomy, which uses the Penumbra system (Penumbra Inc., Alameda, CA, USA). Stent retrieval is a method of clot removal by capturing and removing the thrombus with a stent retriever, such as the Solitaire AB/FR (Medtronic, Irvine, CA, USA) or Trevo (Stryker, Kalamazoo, MI, USA). Balloon guide catheters, adjuvant local lytic infusion, intracranial or extracranial angioplasty, and/or stenting were implemented as needed.
9
Mechanical Thrombectomy Techniques for Ischemic Stroke
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For intracranial mechanical thrombectomy, the direct-aspiration method, stent retrieval technique, or a combination of both methods was used. The direct-aspiration method refers to a forced arterial suction technique (FAST) that uses the Penumbra system (Penumbra Inc., Alameda, CA, USA).14 (link) The second-generation direct-aspiration system was defined as the Penumbra MAX system. In the stent retrieval technique, the clot is removed by capturing the thrombus and bringing it out of the body, using stent retrievers such as Solitaire AB/FR (Medtronic, Irvine, CA, USA) or Trevo (Stryker, Kalamazoo, MI, USA).1 (link)2 (link)15 (link) Balloon guide catheters such as Cello (Fuji System Corp., Tokyo, Japan) or Optimo (Tokai Medical Products, Aichi, Japan) were used to prevent clot migration by proximal balloon inflation while performing direct aspiration or stent retrieval.16 (link) Balloon guide catheters were occasionally used for the remote aspiration method by inflating the balloon and aspirating the guide catheter itself.17 (link)18 (link) Intracranial or extracranial angioplasty and/or stenting was sometimes performed at the discretion of physicians if necessary.
10
Intravenous Thrombolysis and Mechanical Thrombectomy
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Medical management included intravenous thrombolysis (IVT) with alteplase at 0.6 mg/kg (approved dose in Japan). The MT procedure including stent retriever thrombectomy (Solitaire [Medtronic, Irvine, CA, USA]; Trevo [Stryker Neurovascular, Fremont, CA, USA]), direct aspiration (Penumbra aspiration catheter [Penumbra, Alameda, CA, USA]), or combination of both techniques was primarily used at the discretion of the operator.
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