Haussen Diogo C, Lima Andrey, Nogueira Raul G
Emory University School of Medicine/Grady Memorial Hospital, Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA.
J Neurointerv Surg. 2016 Mar;8(3):295-9. doi: 10.1136/neurintsurg-2014-011613. Epub 2015 May 6.
To report our single-center initial experience using the Trevo XP ProVue Retriever 3×20 mm ('Baby Trevo') for distal intracranial occlusions.
We performed a retrospective review of our interventional database for consecutive patients who underwent treatment for acute ischemic stroke with the Baby Trevo device between February and December 2014.
Of 134 patients treated during the study period, 8 underwent treatment with the Baby Trevo for distal occlusions. Their mean age was 51±20 years, 5 (62.5%) were male, mean baseline National Institutes of Health Stroke Scale was 19±5. The mean interval between the time the patient was last-known normal to groin puncture was 527±285 min, and the overall procedural length was 110±26 min. Intra-arterial tissue plasminogen activator was used in 5 (62.5%) cases. The device was used for a total of 10 branches: five middle cerebral artery (four superior M3 and one inferior M3), three anterior cerebral arteries (two pericallosal and one callosomarginal), and two posterior cerebral arteries (one P2 and one P3) occlusions. All patients achieved complete recanalization of the artery targeted by the Baby Trevo (arterial occlusive lesion 3). Good capillary reperfusion (TICI 2b-3) was noted in 6 (75%) cases. One pass was performed in 7 vessels and 2 passes in three branches. Vasospasm was noted in 5 (62.5%) of the vessels and fully responded to intra-arterial vasodilator infusion. Follow-up MRI revealed no infarct within the territory vascularized by the artery targeted by the Baby Trevo in 4 cases, partial infarct in 5, and complete infarct in 1. Two patients had parenchymal hematomas (one PH1 and one PH2). No vessel perforations, dissections, or subarachnoid hemorrhage were noted.
Our initial data suggest that treatment of distal cerebrovascular occlusions with the Trevo XP 3×20 mm Retriever is feasible. Although this device emerges as a promising technology for small and tortuous distal intracranial vessels, larger studies are still necessary to establish its safety and clinical benefit.
报告我们使用Trevo XP ProVue取栓器3×20毫米（“迷你Trevo”）治疗颅内远端闭塞的单中心初步经验。
我们对介入数据库进行了回顾性分析，纳入了2014年2月至12月期间使用迷你Trevo装置治疗急性缺血性卒中的连续患者。
在研究期间接受治疗的134例患者中，有8例使用迷你Trevo治疗远端闭塞。他们的平均年龄为51±20岁，5例（62.5%）为男性，平均基线美国国立卫生研究院卒中量表评分为19±5分。患者最后一次已知正常到腹股沟穿刺的平均间隔时间为527±285分钟，整个手术时长为110±26分钟。5例（62.5%）患者使用了动脉内组织纤溶酶原激活剂。该装置共用于10个分支：5个大脑中动脉（4个M3段上干和1个M3段下干）、3个大脑前动脉（2个胼周动脉和1个胼缘动脉）以及2个大脑后动脉（1个P2段和1个P3段）闭塞。所有患者迷你Trevo靶向的动脉均实现完全再通（动脉闭塞病变3级）。6例（75%）患者出现良好的毛细血管再灌注（脑梗死溶栓分级2b - 3级）。7条血管进行了1次操作，3个分支进行了2次操作。5条（62.5%）血管出现血管痉挛，经动脉内输注血管扩张剂后完全缓解。随访磁共振成像显示，4例患者迷你Trevo靶向的动脉供血区域内无梗死，5例有部分梗死，1例有完全梗死。2例患者出现实质内血肿（1例为1级，1例为2级）。未发现血管穿孔、夹层或蛛网膜下腔出血。
我们的初步数据表明，使用Trevo XP 3×20毫米取栓器治疗远端脑血管闭塞是可行的。尽管该装置对于细小且迂曲的颅内远端血管是一项有前景的技术，但仍需要更大规模的研究来确定其安全性和临床益处。
