Optimizing Tigertriever adjustable stentriever technique: Operators' experience

Abstract

The Tigertriever is a novel, radially adjustable stentriever that addresses limitations in traditional mechanical thrombectomy devices by providing enhanced user control over clot integration. This provides the ability to adapt to patient-specific factors such as varying vessel sizes and clot compositions and may be particularly crucial for ensuring efficacy and safety in distal locations. This consensus paper synthesizes the clinical techniques from a consortium of experienced international operators. It outlines the current data on the Tigertriever, discusses the new operator-controlled capabilities, and provides a recommended approach for both proximal and distal mechanical thrombectomy, emphasizing the "FLEX" approach (Fast Controlled Expansion with Relaxation) for optimal integration and reduced clot disruption.

Keywords: Stroke; Tigertriever; mechanical thrombectomy; stent retriever; stentriever.

Figure 1.

The Tigertriever device in the (A) closed configuration, (B) expanded configuration, and (C) the distal embolic net with the small filter-like pore sizes highlighted in green.

Figure 2.

Demonstration of the slide-push physics (A) Graph of normalized forces in a frictionless environment performed on viscoelastic biomaterials.^, The radial force needed to penetrate the thrombus decreases when the device foreshortening creates perpendicular sliding motion (ξ > 0). (B) Illustration of the directional forces.

Figure 3.

The visual cues associated with Tiger's stages of expansion. The images depict T21 in a 4.5-mm internal diameter (ID) straight tube with a wall thickness of 0.12 mm, similar to the ICA and MCA, and a synthetic clot. The series on the left and right are identical, with the right adding annotations to highlight the progressive changes for each phase of expansion: (A) Initial wall apposition–seen in the distal section of the device. (B) Continued expansion opens the stent further and increases apposition across the proximal section. Once fully apposed, only the distal end moves inward, as noted by its change in angulation from image B to C. (C) Maximum expansion is indicated by a 90-degree angle at the device apex. (D) Overexpansion is displayed by an acute angle at the apex as the distal end folds inward.

Figure 4.

Relaxation facilitates entry into an access catheter. (A) Growing distention as the expanded device enters the guide catheter. (B) The resultant curved end when continuing to withdraw an overexpanded device into the catheter; the distal marker is now involuted and proximal to the tip of the distal embolic net. (C) The desired adjustment to the guide catheter diameter from (A) to correct distention and prevent hooking.