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急性缺血性脑卒中机械取栓中Tigertriever与自膨式支架取栓器的比较:单中心经验

Comparison of the Tigertriever and Self-expanding Stent Retrievers for Mechanical Thrombectomy of Acute Ischemic Stroke: A Single-center Experience.

作者信息

Shindo Koichiro, Uchida Kazutaka, Shirakawa Manabu, Tsuji Shoichiro, Kuwahara Shuntaro, Kuramoto Yoji, Yoshimura Shinichi

机构信息

Department of Neurosurgery, Hyogo Medical University.

Department of Epidemiology, Hyogo Medical University.

出版信息

Neurol Med Chir (Tokyo). 2025 May 15;65(5):247-254. doi: 10.2176/jns-nmc.2024-0297. Epub 2025 Mar 21.

Abstract

Stent retrievers, including the novel Tigertriever, are important in mechanical thrombectomy for acute ischemic stroke due to a proximal large-vessel occlusion within the anterior circulation. We aimed to assess the efficacy and safety of the Tigertriever compared to self-expanding stent retrievers like EmboTrap, Solitaire, Trevo, or Tron. Patients treated at a stroke center for intracranial vessel occlusion in the anterior circulation between August 2022 and August 2024 were evaluated. The primary outcome was a modified first-pass effect, defined as a modified thrombolysis in cerebral infarction grade of 2b-3 after the first pass. Secondary outcomes included the first-pass effect, device-related serious adverse events, embolization in new territory, and hemorrhagic complications within 24 hours post-procedure. Data from 104 hemispheres in 103 patients were analyzed (24 in the Tigertriever group and 80 in the stent-retriever group). The Tigertriever group demonstrated a higher modified first-pass effect (70.8% vs. 52.5%; adjusted odds ratio 3.17; 95% confidence interval 1.06-9.47; p = 0.02). Although not statistically significant, vessel dissection (0% vs. 3.8%), subarachnoid hemorrhage (20.8% vs. 32.5%), and symptomatic intracranial hemorrhage (4.2% vs. 12.5%) within 24 hours post-procedure were lower in the Tigertriever group. No significant differences were observed in the first-pass effect or embolization in the new territory between the 2 groups. The Tigertriever might be effective for anterior circulation intracranial vessel occlusion, achieving a higher rate of modified first-pass effect. It might also be associated with minimal serious procedural complications, indicating its safety profile.

摘要

包括新型Tigertriever在内的取栓支架,对于前循环近端大血管闭塞所致急性缺血性卒中的机械取栓治疗至关重要。我们旨在评估Tigertriever与EmboTrap、Solitaire、Trevo或Tron等自膨式取栓支架相比的疗效和安全性。对2022年8月至2024年8月期间在一家卒中中心接受前循环颅内血管闭塞治疗的患者进行了评估。主要结局是改良首次通过效应,定义为首次通过后改良脑梗死溶栓分级为2b - 3级。次要结局包括首次通过效应、与器械相关的严重不良事件、新区域栓塞以及术后24小时内的出血并发症。分析了103例患者104个半球的数据(Tigertriever组24例,取栓支架组80例)。Tigertriever组显示出更高的改良首次通过效应(70.8%对52.5%;调整比值比3.17;95%置信区间1.06 - 9.47;p = 0.02)。尽管无统计学意义,但Tigertriever组术后24小时内的血管夹层(0%对3.8%)、蛛网膜下腔出血(20.8%对32.5%)和有症状颅内出血(4.2%对12.5%)发生率较低。两组在首次通过效应或新区域栓塞方面未观察到显著差异。Tigertriever可能对前循环颅内血管闭塞有效,实现更高的改良首次通过效应发生率。它也可能与极少严重操作并发症相关,表明其安全性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ad10/12137058/22827428289c/1349-8029-65-5-0247-g001.jpg

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