Stent retriever

• Effectiveness and Safety of Mechanical Thrombectomy in Large-Vessel-Occlusion Mild Stroke: Insights from the ASSIST Registry
• Optimizing stent retrievers for mechanical enhancement and in vitro testing in acute ischemic stroke models
• Efficacy and Safety of a Dedicated Device for Cerebral Venous Thrombectomy: A Pilot Randomized Clinical Trial
• The safety and efficacy of pRESET stent retriever for treatment of thrombo-embolic stroke; a systematic review and meta-analysis
• Soft partial release of non-aggressive stent retriever technique for very distal arterial occlusion stroke
• Mechanical thrombectomy failure in anterior and posterior circulation stroke: current results from a high-volume comprehensive center
• International practice patterns and perspectives on endovascular therapy for the treatment of cerebral venous thrombosis
• A direct aspiration first-pass technique (ADAPT) for acute ischemic stroke thrombectomy: Indications, technique, and emerging devices

Stent retrievers, approved by the U.S. Food and Drug Administration in 2012, are tiny mesh tubes that grab and extract blood clots in blocked arteries

Stent retriever thrombectomy is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation ¹⁾.

Several stent retrievers are currently used in mechanical thrombectomy (MT) to treat acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). These devices vary in design, performance, and specific applications. Below is an overview of notable stent retrievers:

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### 1. Solitaire™ FR (Medtronic) - Design:

1. Self-expanding nitinol stent.
2. Features a closed-cell design to ensure consistent clot engagement.

- Clinical Performance:

1. One of the most studied and widely used stent retrievers.
2. Demonstrated high recanalization rates (~85-90%) in clinical trials like SWIFT and SWIFT PRIME.

- Advantages:

1. Robust safety and efficacy data.
2. High first-pass efficacy and low risk of distal embolization.

- Applications:

1. Suitable for a variety of clot types and vessel anatomies.

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### 2. Trevo XP ProVue Retriever (Stryker) - Design:

1. Open-cell nitinol design with varying radial force along its length.
2. Radiopaque, allowing for real-time visualization under fluoroscopy.

- Clinical Performance:

1. Supported by trials like TREVO 2 and DAWN, which validated its safety and efficacy in MT.
2. Often favored for its ability to effectively remove large, firm clots.

- Advantages:

1. Effective in both anterior and posterior circulation strokes.
2. Low complication rates and high recanalization success (~86-90%).

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### 3. EmboTrap II (Cerenovus, Johnson & Johnson) - Design:

1. Dual-layer nitinol stent retriever designed to trap and remove thrombi while preserving endothelial integrity.

- Clinical Performance:

1. Demonstrates high rates of complete reperfusion and low rates of symptomatic intracranial hemorrhage.
2. Used in a variety of clinical settings, especially for fibrin-rich clots.

- Advantages:

1. Gentle clot retrieval, reducing vessel damage.
2. High rates of first-pass success.

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### 4. Capture L (Balt) - Design:

1. Braided nitinol stent retriever optimized for larger vessels.
2. Features a large distal section to capture and extract clots effectively.

- Clinical Performance:

1. Effective in treating LVOs in the anterior circulation.

- Advantages:

1. Specifically designed for larger clots and vessel diameters.

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### 5. Revive SE (Codman Neuro, Johnson & Johnson) - Design:

1. Laser-cut nitinol stent with a hybrid design combining open and closed cells.

- Clinical Performance:

1. Known for smooth deployment and consistent clot removal.

- Advantages:

1. Reliable for medium-to-large vessel occlusions.
2. Minimal risk of distal embolization.

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### 6. Aperio (Acandis) - Design:

1. Self-expanding nitinol device with unique strut configuration for clot integration.

- Clinical Performance:

1. Used in European stroke centers; preliminary data suggests efficacy similar to Solitaire and Trevo.

- Advantages:

1. Gentle on vessel walls, reducing complications.

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### 7. Tigertriever (Rapid Medical) - Design:

1. Adjustable stent retriever that allows physicians to control the device diameter during deployment.

- Clinical Performance:

1. Innovative adjustability enables customized engagement with clots, potentially improving outcomes.

- Advantages:

1. Real-time adjustability offers flexibility during thrombectomy.
2. High first-pass success rates.

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### 8. MindFrame Capture LP (Medtronic) - Design:

1. Miniature nitinol stent retriever designed for small vessels and distal occlusions.

- Clinical Performance:

1. Effective for smaller clots, especially in medium and distal vessels.

- Advantages:

1. Ideal for more challenging anatomies.
2. High safety profile.

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### Comparison of Stent Retrievers

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### Conclusion: The pRESET stent retriever joins a competitive field of devices, with Solitaire and Trevo serving as benchmarks due to their extensive data and consistent performance. Emerging devices like Tigertriever and EmboTrap II offer innovative solutions that may address specific challenges in clot retrieval. The choice of stent retriever often depends on individual patient characteristics, clot location, and physician preference.

Stent retriever for acute ischemic stroke treatment

Stent-Retriever for Cerebral Vasospasm Treatment