Kühn Anna Luisa, Wakhloo Ajay K, Lozano J Diego, Massari Francesco, De Macedo Rodrigues Katyucia, Marosfoi Miklos G, Perras Mary, Brooks Christopher, Howk Mary, Rex David E, Gounis Matthew J, Puri Ajit S
Division of Neuroimaging and Intervention, Department of Radiology, New England Center for Stroke Research, Worcester, Massachusetts, USA.
J Neurointerv Surg. 2017 Jun;9(6):541-546. doi: 10.1136/neurintsurg-2016-012454. Epub 2016 Jun 9.
To evaluate the safety and efficacy of the 'Baby Trevo' (Trevo XP ProVue 3×20 mm Retriever) stent retriever for large vessel occlusions (LVOs) in acute ischemic stroke (AIS).
We retrospectively analyzed our stroke database and included all patients treated with the Baby Trevo for distal LVOs in AIS. Patient gender, mean age, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score at presentation, and modified Rankin Scale (mRS) score at baseline and 90-day follow-up were documented. Reperfusion rates for the vessels treated were recorded using the Thrombolysis in Cerebral Infarction (TICI) classification. Occurrence of vasospasm and new or evolving infarcts in the treated vascular territory was documented.
Thirty-five subjects with a mean NIHSS score of 18 were included. The Baby Trevo device was used in 38 branches of the anterior and posterior circulations. TICI 2b/3 blood flow was restored after one single pass in 20/38 (52.6%) and after two or three passes in 11 vessels. The remaining vessels required either more than three passes, showed less than a TICI 2b/3 reperfusion (n=3), or demonstrated failure to retrieve the clot (n=4). TICI 2b/3 reperfusion was achieved in 30 patients (85.7%). No vessel injuries, rupture, or significant vasospasm were seen. Overall, a mRS score of ≤2 was seen in 56.5% of the subjects successfully treated with the Baby Trevo at 90 days and in 81.3% of surviving patients; seven patients died (20%).
Our preliminary data suggest that the 'Baby Trevo' achieves a high recanalization rate without any significant risk. Larger cohort studies are needed to validate the clinical benefit.
评估“婴儿Trevo”（Trevo XP ProVue 3×20毫米取栓器）支架取栓器治疗急性缺血性卒中（AIS）大血管闭塞（LVO）的安全性和有效性。
我们回顾性分析了卒中数据库，纳入了所有使用婴儿Trevo治疗AIS远端LVO的患者。记录患者的性别、平均年龄、血管危险因素、就诊时的美国国立卫生研究院卒中量表（NIHSS）评分以及基线和90天随访时的改良Rankin量表（mRS）评分。使用脑梗死溶栓（TICI）分类记录治疗血管的再灌注率。记录治疗血管区域内血管痉挛以及新的或进展性梗死的发生情况。
纳入了35名平均NIHSS评分为18分的受试者。婴儿Trevo装置用于前循环和后循环的38个分支。单次通过后20/38（52.6%）的血管恢复了TICI 2b/3血流，11根血管在两次或三次通过后恢复。其余血管需要超过三次通过，显示TICI 2b/3再灌注不足（n = 3），或未能取出血栓（n = 4）。30名患者（85.7%）实现了TICI 2b/3再灌注。未观察到血管损伤、破裂或明显的血管痉挛。总体而言，在90天时成功使用婴儿Trevo治疗的受试者中，56.5%的患者mRS评分≤2，在存活患者中这一比例为81.3%；7名患者死亡（20%）。
我们的初步数据表明，“婴儿Trevo”实现了高再通率且无任何重大风险。需要更大规模的队列研究来验证其临床益处。
