Introduction: Timely revascularization in the setting of acute large vessel occlusion has been shown to be a major factor in good clinical outcome. The Trevo device is a stent-like retriever designed to remove thrombus in patients experiencing an acute ischemic stroke. We report our experience at Capital Institute for Neurosciences on the results of the use of the Trevo Pro-Retriever in acute stroke patients.
Methods: The Trevo system was used in 43 patients with acute ischemic stroke. Procedure success (successful revascularization rate, TICI (thrombolysis in cerebral infarction) score 2a or better) and neurological outcomes (modified Rankin Scale (mRS) at baseline and 90 days following procedure) were recorded.
Results: 43 patients were treated with the Trevo Pro-Retriever. 36 of 40 patients (90%) had successful revascularization. The symptom onset to revascularization time was greater than 8 hours in 13 patients. The 90-day follow up mRS score was collected in 12 patients and averaged 2.4; with baseline mRS scores of 3.6. An mRS score of 2 or less was found in 50% (6 /12) of patients at 90 days following procedure.<br />In the 12 patients that had greater than 8 hours between symptom onset and revascularization, 11 (92%) had successful revascularization. The average baseline mRS for this group of patients was 4.6. Five patients were followed through 90 days. These patients had a baseline mRS of 4.2 and a 90 day mRS of 2.8. Only 2 of 5 patients showed a significant functional improvement.
Conclusions: Thirteen of our patients exceeded the 8-hours-window. Successful revascularization rates and neurological outcomes in this population have not been reported. The Trevo Pro-Retriever has been shown to be an effective tool in treating acute ischemic stroke. Our experience elucidate this but also shed light on the potential use of this device beyond the eight-hour window, an advantage that warrants further investigation.
Patient Care: The use of a new tool
Learning Objectives: 1)Describe the outcome with the use of Trevo
2)Discuss recanalization rates with the use of Trevo
3)Identify a new effective tool for treatment of acute ischemic stroke