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Ask your administrator if you think this is wrong. ====== Stent Retriever Types ====== ===== 📚 Classification Overview ===== Stent retrievers are classified based on **design**, **mechanism of action**, **size**, **material**, **clinical application**, and **deployment technique**. ==== 🔧 By Design and Mechanism ==== * [[Single-Stent Retriever]]: Single stent deployed inside the clot to capture it during retrieval. * [[Double-Stent Retriever]]: Dual stent-like structures designed for better clot entrapment in large occlusions. * [[Self-Expanding Stents]]: Automatically expand upon deployment to increase clot contact surface. ==== 📏 By Size and Diameter ==== * **Small**: For delicate procedures and small-caliber vessels. * **Medium**: Standard size for middle cerebral arteries. * **Large**: For large vessels (e.g., internal carotid, basilar). ==== ⚙️ By Material Composition ==== * **Nitinol** (Nickel-Titanium alloy): Offers flexibility, durability, and shape-memory. * **Polymers**: Occasionally combined for additional flexibility or support. ==== 🏥 By Clinical Application ==== * **Acute Ischemic Stroke**: Primary use in neurointervention. * **Other Vascular Territories**: Explored use in coronary or peripheral procedures. ==== 🚀 By Deployment Mechanism ==== * **Manual Deployment**: Controlled by the physician. * **Catheter-Driven/Automated**: Enhanced control with system-guided expansion. ==== 🧲 By Retrieval Method ==== * **Proximal Retrieval**: Engages clot closest to the heart. * **Distal Retrieval**: For selective or distal occlusion removal. ---- ===== 🧪 Types of Stent Retrievers ===== === 1. Solitaire™ FR (Medtronic) === * **Design**: Self-expanding, closed-cell nitinol. * **Data**: SWIFT, SWIFT PRIME (~85–90% success). * **Pros**: High first-pass efficacy, well-studied. * **Use**: Versatile across anatomies. === 2. Trevo XP ProVue (Stryker) === * **Design**: Open-cell nitinol with radial force gradient. * **Data**: TREVO 2, DAWN. * **Pros**: Radiopaque, effective for firm clots. * **Use**: Both anterior and posterior circulation. === 3. EmboTrap II (Cerenovus) === * **Design**: Dual-layer nitinol for thrombus trapping. * **Data**: High reperfusion, low hemorrhage. * **Pros**: Gentle on vessels, effective for fibrin-rich clots. === 4. Capture L (Balt) === * **Design**: Braided nitinol optimized for large vessels. * **Use**: Anterior circulation LVOs. * **Pros**: Effective for large clot burden. === 5. Revive SE (Codman Neuro) === * **Design**: Hybrid laser-cut nitinol (open/closed cells). * **Pros**: Reliable deployment, medium-large occlusions. === 6. Aperio (Acandis) === * **Design**: Self-expanding nitinol with unique struts. * **Data**: European use; early data promising. * **Pros**: Low vessel trauma, comparable efficacy. === 7. Tigertriever (Rapid Medical) === * **Design**: Adjustable diameter during deployment. * **Pros**: Real-time control, high adaptability. * **Use**: Tailored engagement of various clot types. === 8. MindFrame Capture LP (Medtronic) === * **Design**: Mini nitinol stent for distal/small vessels. * **Pros**: Excellent in complex anatomies. ---- ===== 📊 Comparison Table ===== ^ **Device** ^ **Material** ^ **Success Rate** ^ **Use** ^ **Key Features** ^ | Solitaire™ FR | Nitinol | 85–90% | General | Closed-cell design | | Trevo XP ProVue | Nitinol | 86–90% | Firm clots | Radiopaque, open-cell design | | EmboTrap II | Nitinol | ~90% | Fibrin-rich clots | Dual-layer, gentle on vessel wall | | Capture L | Nitinol | ~85% | Large vessels | Braided for clot entrapment | | Revive SE | Nitinol | ~85% | Medium-large vessels | Hybrid cell pattern | | Aperio | Nitinol | 85–90% | European centers | Flexible, low trauma | | Tigertriever | Nitinol | High | Customizable deployment | Adjustable diameter | | MindFrame Capture LP | Nitinol | 80–85% | Distal occlusions | Miniature, high flexibility | ---- ===== 🧾 Conclusion ===== Stent retrievers play a central role in mechanical thrombectomy for AIS. While Solitaire™ and Trevo remain benchmarks due to robust clinical validation, newer devices such as **Tigertriever** and **EmboTrap II** offer innovative features tailored to clot morphology and vessel anatomy. The optimal choice hinges on **patient-specific factors**, **clot characteristics**, and **operator preference**. ===== Scoping reviews ===== In a [[scoping review]] Song et al.from: - Austin Health, Melbourne (Radiology) - St Vincent’s Health, Melbourne (Interventional Neuroradiology) - Monash Health, Melbourne (Neurosurgery & Imaging) - Eastern Health/MU, Melbourne - Northern Health/Univ. of Melbourne, Melbourne - SAHMRI, Adelaide - Deakin Univ., Geelong published in the [[Journal of Clinical Neuroscience]] with the purpose to map the [[landscape]] of stent retriever devices used in [[mechanical thrombectomy]] for [[acute ischemic stroke]], stratified by [[device]] type and occlusion location. They concluded that [[Solitaire]] and [[Trevo]] dominate clinical use (~57 % of cases), primarily in M1 and ICA occlusions. Many devices remain under‑studied, especially in distal (ACA, M3+) occlusions. There is a notable evidence gap for newer [[stent retriever]]s in medium/distal vessel territory ((Song J, Zhou KZ, Pavlin‑Premrl D, et al. Types of stent retrievers used in mechanical thrombectomy for acute ischaemic stroke: A scoping review. J Clin Neurosci. 2025 Jun 23;138:111412. doi:10.1016/j.jocn.2025.111412.)). ---- This review, while comprehensive in device enumeration, falls short in [[critical appraisal]]. By pooling data from 133 heterogeneous studies without quality stratification or [[bias assessment]], it gives an inflated sense of evidence. The emphasis on device frequency—rather than outcomes or head‑to‑head efficacy—renders the conclusions superficial. The assertion of a “strong evidence base” for conventional devices is misleading; no meta‑analysis or performance metrics are provided. The claim that distal occlusions are understudied is unsurprising, but the authors offer no actionable framework or proposals for future targeted trials. The review reads more like a registry report than a scoping synthesis intended to inform practice. Novelty is minimal, relevance limited. ===== Verdict ===== Fail. A descriptive registry devoid of depth, critique, or synthesis. ===== Take‑home message for neurosurgeons ===== This scoping review inventories devices and locations but provides zero guidance on device choice or procedural strategy. Relying on mere frequency does not equate to best practice. ===== Bottom line ===== Inventory, not insight. ===== Rating (0–10) ===== 2/10 ===== Citation ===== Corresponding author: janesong1029@gmail.com. The article was published online ahead of print on June 23, 2025. stent_retriever_types.txt Last modified: 2025/06/25 09:39by administrador