The use of the NeVa stent-retriever for bail-out mechanical thrombectomy.

Abstract

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.