The NeVa stent-retriever - a single-centre real-world experience

Abstract

Stent-retriever-based mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). First-pass effect (FPE) is one most powerful predictors of positive outcomes in LVO AIS patients treated with MT. We performed an independent central reader review of our prospectively maintained database to identify all patients treated first with the NeVa stent retriever at our single high-volume Comprehensive Stroke Centre.Overall, 89 patients met our inclusion criteria. The median age was 73 yrs (range 28-88; 52% male). The median presentation NIHSS was 16 (range 5-30) and 49% received IV tPA prior to MT. 93% of target occlusions were in the anterior circulation (n = 83) with a median ASPECT score on plain CT of 8 (range 5-10). A Balloon Guide Catheter (BGC) was used in 80% of cases and a distal aspiration catheter was used in all cases. Longer NeVa models (≥29 mm) were used in 89% of cases. FPE was demonstrated in 57% of cases (eTICI score of ≥2c) with modified FPE demonstrated in 65.1% of cases (eTICI score of ≥2b (67%)). A final eTICI score of ≥2c was achieved in 87% of cases. Good functional outcome (mRS ≤2) was achieved in 40% of patients (n = 81).The NeVa stent-retriever has a very high rate of FPE and final recanalization in this real-world cohort of patients from the NeVa One registry. These results are higher than those previously published and may support longer NeVa device use with a BGC and proximal aspiration to optimize FPE.

Keywords: NeVa device; first-pass effect; large vessel occlusion; mechanical thrombectomy; stroke.

Figure 1.

A patient in their 70s presented with an NIHSS score of 6 and ASPECT score 9 (figure 1(a)). After CTA confirmed an occlusion, the patient was transferred for MT. Initial angiography confirmed occlusion of the right mid-M1 (figure 1(b)). A NeVa 4.0 × 30 mm was deployed for 5 minutes per our standard practice. Angiography demonstrated eTICI 3 recanalization after the first pull (figure 1(d)). The 24-hour CT scan showed infarction within the basal ganglia (ASPECT score 8) with high density seen in the Sylvian fissure (figure 1(e)) with minimal sub-arachnoid haemorrhage seen on the virtual non-contrast spectral reconstruction (figure 1(f)).