Abstract 143: Tigertriever in the Treatment of Acute Ischemic Stroke with Underlying Intracranial Atherosclerotic Disease

Introduction The Tigertriever stentretriever provides operators the ability to manually regulate the radial expansion of the device. In vitro testing of the Tigertriever has demonstrated that it exerts a radial force twice as powerful as that exerted by self‐expanding stentretrievers. The enhanced radial force of the Tigertriever may improve the recanalization of patients with acute large vessel occlusion (LVO) due to underlying intracranial atherosclerosis (ICAD). We analyzed the TIGER trial dataset to determine the safety and effectiveness of Tigertriever in the recanalization of patients with underlying ICAD and acute ischemic stroke. Methods An independent imaging laboratory assessed the presence of ICAD. ICAD was present if at least ≥ one of the following features were observed: (1) angiographic evidence of taper‐shape occlusion, (2) presence of arterial calcific lesions, and/or (3) remnant stenosis > 70% after mechanical thrombectomy (MT). Vessel diameter changes were studied by measuring the occlusion site and the proximal parent vessel using the best projection of pre‐ and post‐thrombectomy DSA images. additionally, a retrospective analysis of revascularization rates during the first attempt was conducted. The first‐pass effect (FPE) was defined as the achievement of successful recanalization (mTICI 2b‐3) using only one pass of the Tigertriever device. Results A total of 160 patients from the TIGER trial were included in our study, with 32 (20%) patients having ICAD. An increase in the mean diameter of the vessel at the site of the occlusion was observed post‐thrombectomy (1.5 ± 0.73 mm vs 1.88 ± 0.67 mm, p < 0.01). The diameter in the proximal parent vessel did not change after thrombectomy (2.22 ± 0.68 mm vs 2.32 ± 0.64 mm; p = 0.34). There were no symptomatic hemorrhages. The FPE was documented in of 15 out of 32 (46.8%) patients. Conclusion The Tigertriever device is safe and effective in the revascularization of patients with LVO and underlying ICAD. The diameter of the occluded arterial segment with underlying ICAD increased after mechanical thrombectomy with Tigertriever. The FPE with the Tigertriever in this subpopulation of the TIGER trial was 46.8%.