Neurointerventional Report Trevo versus Solitaire a Head-to-Head Comparison Between Two Heavy Weights of Clot Retrieval Nuno Mendonc ¸a, MD, Alan Flores, MD, Jorge Pagola, MD, PhD, Marta Rubiera, MD, PhD, David Rodr´ ıguez-Luna, MD, M Angels De Miquel, MD, Pere Cardona, MD, Helena Quesada, MD, Paloma Mora, MD, Jos´ e Alvarez-Sab´ ın, MD, PhD, Carlos Molina, MD, PhD, Marc Rib´ o, MD, PhD From the Department of Neurology, University Hospital of Coimbra, Coimbra, Portugal (NM); Stroke Unit, Department of Neurosciences, Hospital Universitari Vall d’Hebron, Departament de Medicina, Universitat Aut ` onoma de Barcelona, Barcelona, Spain (AL, JP, MR, DRL, JAS, CM, MR); Neuroradiolog´ ıa, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain (MADM, PM); and Servicio de Neurolog´ ıa, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain (PC, HQ). Keywords: Acute embolectomy, in- terventional neuroradiology, reperfusion, stroke, thrombectomy. Acceptance: Received February 13, 2012, and in revised form April 18, 2012. Accepted for publication May 6, 2012. Correspondence: Address correspon- dence to Marc Rib ´ o, MD, PhD. Stroke Unit, Department of Neurosciences, Hos- pital Universitari Vall d’Hebron. Departa- ment de Medicina, Universitat Aut` onoma de Barcelona. Ps. Vall d’Hebr´ on, 119- 129. 08035, Barcelona. Spain. E-mail: marcriboj@hotmail.com. J Neuroimaging 2012;XX:1–4. DOI: 10.1111/j.1552-6569.2012.00730.x ABSTRACT BACKGROUND AND PURPOSE Recent reports have indicated that mechanical thrombectomy may have potential to treat acute ischemic stroke. However, few comparative studies of neurothrombectomy devices are reported. This study aims to compare the safety and effectiveness of two retrievable stent systems in acute ischemic stroke patients. METHODS A prospective study comparing the clinical, radiological, and functional outcome of 33 patients with an angiographically verified occlusion of the anterior cerebral circulation. Patients were treated either with Trevo Retriever TM or Solitaire Stent TM according to the neurointerventionalist preference. Successful recanalization was defined as TICI grade 2a to 3. Good outcome was defined as a modified Rankin Scale score ≤ 2 at 3 months. RESULTS Revascularization was achieved in 10 patients (77%) in the Trevo group and in 12 (60%) of the Solitaire group (P = .456). Rate of symptomatic ICH was 0% for Trevo versus 15% for Solitaire (P = .261). Four patients (30%) died during the 3-month follow-up period in the Trevo versus 5 patients (25%) in the solitaire group (P = 1.000). Rate of good outcome was 38% and 40% for Trevo and Solitaire respectively (P = .435). CONCLUSIONS Our study showed no significant differences between both stentrievers. Moderately high recanalization rates are possible with both, however larger series may depict safety- related variations. Recent reports have indicated that mechanical thrombectomy may have potential as a treatment in acute ischemic stroke. 1 In fact, stent-based recanalization techniques are increasingly used in stroke caused by large vessel occlusion. 2,3 There are several publications reporting on the efficacy of several such de- vices. Namely, the Mechanical Embolus Removal In Cerebral Ischemia (MERCI) trial reported on the efficacy of MERCI re- triever, a device used to recanalize occluded vessels in patients ineligible for tPA. Multi-MERCI investigators also showed that mechanical thrombectomy is efficacious in opening intracranial vessels of patients in which IV tPA failed to induce recanaliza- tion. 1 This group of patients may benefit from thrombectomy within 6 hours of stroke onset. 4 Moreover, other smaller studies have addressed the value of newer stents. 2,3 As a result, there is a large and growing list of various neu- rothrombectomy devices available to clinicians. However, very few direct human comparative studies are reported in the neu- rothrombectomy literature. This study aims to compare the safety and effectiveness of two retrievable stent systems: Trevo Retriever TM (TR) (Con- centric Medical Inc., CA, USA) and the Solitaire Stent TM (ST) (EV3 Inc., CA, USA) in acute ischemic stroke patients with large artery occlusions (Fig 1A). The TR using Stentriever TM technology is a novel embolec- tomy device specifically designed to remove the thrombus in acute ischemic stroke secondary to large vessel thromboem- bolism. TR is a stent-like device that aims to integrate the clot into the stent structure, and allows the user to retract the de- vice and clot from the blood vessel. The ST is a self-expanding stent that offers the unique capability of being able to be fully deployed and then completely retrieved if it has not been de- tached 5 (Fig 1B). Copyright ◦ C 2012 by the American Society of Neuroimaging 1