Fairhead Rory, Mancuso-Marcello Marco, Ahmed Rafee, Lee Keng Siang, Nikola Christos, Parkin Katherine, Klefti Giovanna, Makalanda Levansri, Wong Ken, Lansley Joe, Przyszlak Michael, Spooner Oliver, Bhogal Pervinder
Department of Radiology and Interventional Neuroradiology, The Royal London Hospital, London, UK.
Department of Neurosurgery, National Neuroscience Institute, Singapore.
Interv Neuroradiol. 2025 Sep 29:15910199251381491. doi: 10.1177/15910199251381491.
IntroductionMechanical thrombectomy (MT) has become the gold-standard treatment for large vessel occlusion (LVO), however, in many cases, clots cannot be removed with the initial device. We assessed the safety and efficacy of the NeVa stent-retriever when used for bailout, in a real-world scenario where a range of initial devices have failed.MethodsWe reviewed our prospectively maintained database to identify all patients treated with the NeVa device after another device had failed to achieve satisfactory recanalisation. We recorded the baseline demographics, NIHSS, pre- and post-MT imaging data including ASPECT score, eTICI scores, complications and 90-day Modified Rankin Score (mRS).Results39 patients were included with median age 70, 67% male. Median NIHSS at presentation was 17, 11 (28%) received IV tPA prior to MT. A single device prior to NeVa was used in 31 (74%) of cases, with 2 devices used in the remaining patients, in total achieving eTICI ≥ 2b rencanalisation in 4/39 patients (10%). After one NeVa pull, 18 of the remaining 35 eTICI < 2b patients (51%) showed improvement to eTICI ≥ 2b, improving to 26/35 (74%) after multiple NeVa pulls when compared to the pre-NeVa angiographic result. Symptomatic intracranial haemorrhage and subarachnoid haemorrhage occurred in 2/39 (5.1%) and 12/39 (31%), respectively. Functional independence (mRS ≤ 2) at 90 days was seen in 8/35 (23%).ConclusionThe NeVa stent-retriever provides a useful adjunctive device in situations where other devices have failed to achieve recanalisation. Early switching to NeVa rather than repeated pulls with an initial device may be beneficial for timely recanalisation.
引言
机械取栓术（MT）已成为大血管闭塞（LVO）的金标准治疗方法，然而，在许多情况下，最初的器械无法清除血栓。我们在一系列初始器械均失败的真实场景中，评估了NeVa支架取栓器用于补救治疗时的安全性和有效性。
方法
我们回顾了前瞻性维护的数据库，以识别在另一器械未能实现满意再通后接受NeVa器械治疗的所有患者。我们记录了基线人口统计学数据、美国国立卫生研究院卒中量表（NIHSS）评分、MT前后的影像学数据，包括脑缺血早期CT评分（ASPECT）、脑梗死溶栓治疗（eTICI）评分、并发症以及90天改良Rankin量表（mRS）评分。
结果
纳入39例患者，中位年龄70岁，男性占67%。就诊时NIHSS评分中位数为17分，11例（28%）在MT前接受了静脉注射组织型纤溶酶原激活剂（IV tPA）治疗。31例（74%）患者在使用NeVa之前使用了单一器械，其余患者使用了2种器械，总共4/39例患者（10%）实现了eTICI≥2b级再通。在剩余35例eTICI<2b级的患者中，经过一次NeVa取栓后，18例（51%）改善为eTICI≥2b级，与使用NeVa前的血管造影结果相比，多次NeVa取栓后改善至26/35例（74%）。有症状的颅内出血和蛛网膜下腔出血分别发生在2/39例（5.1%）和12/39例（31%）患者中。90天时功能独立（mRS≤2）的患者有8/35例（23%）。
结论
在其他器械未能实现再通的情况下，NeVa支架取栓器是一种有用的辅助器械。早期更换为NeVa而非反复使用初始器械进行取栓可能有利于及时实现再通。
