Abstract
Background
The Tigertriever (Rapid Medical, Israel) is the first manually expandable stent retriever, designed to enhance clot engagement and vessel wall apposition. Despite increasing use, comparative data with the widely adopted Solitaire X device (Medtronic, USA) are limited. This study aimed to compare the safety and efficacy of Tigertriever versus Solitaire in mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusion.
Methods
We retrospectively analyzed 346 MT procedures (May 2019–September 2024). Patients treated with Tigertriever or Solitaire X (with/without aspiration) were matched 1:1 using a nearest-neighbor approach based on age, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and occlusion site. Outcomes included procedural safety (complications, hemorrhage, mortality) and efficacy (number of passes, time to reperfusion, final modified treatment in cerebral infarction, and 3-month modified Rankin Scale) were compared, with propensity score adjustment applied in the analyses.
Results
In total, 268 matched patients (134 per group) were included. Baseline characteristics were balanced, except that Tigertriever patients had longer onset-to-puncture times and more cardioembolic strokes. The Solitaire X group demonstrated a significantly higher first-pass recanalization rate (p = 0.03; adjusted odds ratio (OR) = 1.82, 95% confidence interval (CI): 1.02–3.23, p = 0.04) and required fewer device passes to achieve successful reperfusion (p < 0.001; adjusted OR = 0.19, 95% CI: 0.06–0.56, p = 0.002). In atherosclerotic occlusions, Tigertriever tended to have higher reperfusion and first-pass success rates and better 3-month outcomes. Overall, 90-day functional outcomes did not differ significantly.
Conclusions
Tigertriever and Solitaire demonstrated comparable 3-month functional outcomes, though procedural profiles and subgroup advantages differed. Further randomized trials are warranted.
Keywords: Acute ischemic stroke, large vessel occlusion, mechanical thrombectomy, Tigertriever, Solitaire X
Introduction
Mechanical thrombectomy (MT) using stent retrievers is an established treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). 1 This minimally invasive technique has revolutionized stroke management by significantly improving functional outcomes and reducing long-term disability when performed within appropriate time windows. Among the available thrombectomy devices, the Solitaire™ stent retriever (Medtronic, Irvine, CA, USA) has gained widespread adoption due to its uncomplicated technique, long-term experience of uses with high rates of successful reperfusion. 1 Nonetheless, challenges exist in cases of hard thrombosis, occlusion in patients with vessel diameters greater than 6 mm or atherosclerosis occlusion, prompting the development of next-generation devices aimed at optimizing both efficacy and safety.
One such innovation is the Tigertriever (Rapid Medical, Yoqneam, Israel), a newer-generation stent retriever featuring a unique manually expandable nitinol mesh designed for improved clot integration and vessel wall apposition.2–5 Its adjustable radial force and flexible architecture allow for real-time customization to vessel anatomy, which may be particularly advantageous in tortuous vascular segments or in cases involving firm, fibrin-rich thrombi. Additionally, its controlled expansion mechanism is intended to reduce the risk of endothelial trauma and angioplasty-like effects in vessel stenosis—critical considerations in MT complexity cases.2–5
Despite its promising design, direct comparative data between the Tigertriever and the widely used Solitaire device remain limited, particularly with regard to angiographic results, procedural complications, and long-term functional outcomes.6–8 While early clinical experience and small-scale studies suggest that the Tigertriever may achieve comparable or even superior recanalization rates in select patient population, these data were still limited for this novel mechanism stent retriever.6–8 Moreover, differences in device mechanics, clot interaction, and operator experience may significantly influence procedural success and clinical outcomes. Therefore, this study aims to provide further clinical evidence on the efficacy and safety of MT using the Tigertriever through a comparative study with well-known Solitaire stent retrievers for AIS patients due to LVO in real-world practice.
Materials and methods
Study design and population
This single-center cohort study was conducted from May 2019 to September 2024. Ethical approval for the study was granted by the Institutional Review Board, and the study was conducted in accordance with the STROBE guidelines for observational studies (see Supplemental Materials).
Patient selection
Patients were eligible for inclusion if they met the following criteria: age ≥18 years, AIS due to LVO confirmed by computed tomography angiography (CTA) or magnetic resonance angiography (MRA) involving the internal carotid artery (ICA), M1 or proximal M2 segments, or basilar artery (BA), a National Institutes of Health Stroke Scale (NIHSS) score ≥6, an Alberta Stroke Program Early CT Score (ASPECTS) or posterior circulation ASPECTS (pc-ASPECTS) ≥6, with or without intravenous thrombolysis (IVT) before thrombectomy, groin puncture performed within 6 h of stroke onset, and the use of either Tigertriever or Solitaire as the first-line thrombectomy device. Patients were excluded for pre-stroke modified Rankin Scale (mRS) >2 or lack of mRS data at 3-month follow-up or incomplete/unreliable research data, or refusal to participate in the study.
Matched-pair method and patient cohort
This study employed a retrospective matched-pair design. Patients treated with Tigertriever and Solitaire X were matched 1:1 using nearest-neighbor propensity score (PS) matching without replacement, with a caliper of 0.2 standard deviation (SD). The PS was estimated using logistic regression including age, baseline NIHSS, occlusion site for anterior circulation thrombectomy and age, baseline NIHSS, pc-ASPECTS for posterior circulation thrombectomy.9–13
Although initial matching was done manually based on these variables, a PS for treatment assignment (Tigertriever vs. Solitaire X) was later calculated using logistic regression including relevant baseline covariates (IVT use and onset-to-puncture time). The resulting PS was incorporated as an adjustment variable in subsequent outcome analyses to minimize residual confounding.
Mechanical thrombectomy with Tigertriever
All procedures were performed by experienced neurointerventionalists (>4 years) using either a monoplane (Philips Allura Xper FD20) or biplane (Philips Allura Xper FD10/10) digital subtraction angiography system. Conscious sedation or general anesthesia was used based on clinical indications.
Vascular access was obtained via a long sheath (Neuron Max 088, Penumbra Inc.), positioned in the carotid or vertebral artery. Thrombectomy was performed using the Tigertriever 21 (Rapid Medical) (1.5–6 mm × 32 mm) or Solitaire X (Medtronic, Irvine, CA, USA) (4 mm × 20 mm/4 mm × 40 mm/6 mm × 40 mm) alone or in combination with aspiration catheters (Sofia Plus catheter, MicroVention, CA, USA; Jet 7 catheter, Penumbra, Alameda, CA, USA; React catheter, Medtronic). Device selection was determined by device availability during the study period: only Solitaire X was available from May 2019 to November 2023, whereas only the Tigertriever was used from November 2023 to September 2024.
The Tigertriever features a manually adjustable expansion mechanism, allowing real-time control of stent diameter and radial force (Figure 1). Three major procedural advantages of Tigertriever include: (1) dynamic manual expansion tailored to vessel anatomy and clot properties, (2) elimination of the 3–5 min wait required for Solitaire engagement, (3) possibility of partial deployment within the microcatheter (e.g. for distal M2/M3 migration), and (4) possibility of fast controlled expansion and relaxation in vessel stenosis.
Figure 1.
Variations in the Tigertriever 21 stent retriever configuration according to vessel diameter and tortuosity. In our series, pull levels were typically 3 for M2/A2 occlusion, 4 for M1/M2 occlusion, 5 for M1/ICA occlusion, and 6–8 for ICA occlusion or hard thrombus in proximal M1. ICA, internal carotid artery.
Rescue treatments such as balloon angioplasty or intracranial/extracranial stenting were employed in cases of underlying atherosclerosis. Hemostasis was achieved using manual compression or an Angio-Seal 8F closure device (Terumo).
Research variables
Clinical variables included age, sex, baseline NIHSS score, stroke etiology, and in-hospital severe adverse events. Imaging variables included baseline ASPECTS or pc-ASPECTS assessed on non-enhanced computed tomography (NECT) or diffusion-weighted magnetic resonance imaging (DWI), and occlusion site (ICA, M1, proximal M2, or BA) identified by CTA or MRA. Interventional variables included time from symptom onset to groin puncture, use of IVT, type of anesthesia, thrombectomy technique (stent retriever alone vs. combined), use of rescue therapies (balloon angioplasty and/or stenting), and periprocedural antithrombotic therapy. Outcome measures included final modified treatment in cerebral infarction (mTICI) score, first-pass recanalization, recanalization time, number of device passes, periprocedural complications (e.g. perforation, dissection), thrombus migration, symptomatic intracranial hemorrhage by safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST) criteria, 14 and 90-day mRS score.
Statistical analysis
Data were analyzed using SPSS version 26.0 (SPSS Inc., Chicago, IL, USA) and Stata version 17.0 (StataCorp LLC, College Station, TX, USA). Missing registry data were cross-checked with patients’ medical records; cases with unavailable information were excluded. Continuous variables are presented as medians with interquartile ranges or mean ± SD, and categorical variables as frequencies and percentages. Baseline characteristics were compared using a chi-square test or Fisher's exact test as appropriate for categorical variables, and a Mann–Whitney U test for continuous variables.
Outcomes were assessed using a chi-square or Fisher's exact test, as appropriate, and further analyzed using logistic regression adjusted for baseline imbalances. Subgroup analyses focused on cases with large-artery atherosclerotic occlusions. A p-value <0.05 was considered statistically significant, and effect sizes were reported with 95% confidence intervals (CIs).
Results
Matching results and characteristics of matched cohorts
Between May 2019 and September 2024, a total of 346 thrombectomy procedures was retrospectively reviewed and used for matching. After matching, the baseline characteristics of 268 matched patients (134 in each group) were generally well balanced. Standardized mean differences (SMDs) for key variables were below the conventional threshold of 0.2, except for IVT administration (SMD = 0.21) and onset-to-groin time (SMD = 0.94), indicating moderate to large imbalance (Table 1). These variables were subsequently adjusted for in outcome analyses. The details of baseline clinical, imaging, and interventional characteristics are shown in Table 2.
Table 1.
Post-matching result.
| Tigertriever (n = 134) | Solitaire X (n = 134) | SMD | |
|---|---|---|---|
| Age (mean ± SD) | 66.7 ± 13.4 | 66.8 ± 12.4 | −0.007 |
| Baseline NIHSS (mean ± SD) | 13.5 ± 3.6 | 13.6 ± 4.8 | −0.025 |
| Baseline ASPECTS/pc-ASPECTS (mean ± SD) | 7.53 ± 0.87 | 7.65 ± 0.82 | −0.135 |
| Occlusion site (mean ± SD) | 0.94 ± 0.90 | 1.08 ± 0.94 | −0.157 |
| IVT (%) | 30.1 | 39.2 | −0.207 |
| Onset-to-groin puncture, minute, (mean ± SD) | 324 ± 128 | 225 ± 74 | 0.944 |
SD, standard deviation; NIHSS, National Institutes of Health Stroke Scale; ASPECTS, Alberta Stroke Program Early Computed Tomography Score; pc-ASPECTS, posterior circulation-ASPECTS; IVT, intravenous thrombolysis; SMD, standardized mean difference.
Table 2.
Patients’ clinical, imaging, and interventional characteristics.
| Tigertriever (n = 134) | Solitaire X (n = 134) | p-Value | |
|---|---|---|---|
| Age, year, median (IQR) | 68 (62–76) | 67.5 (59–75) | 0.76† |
| Sex, male, n (%) | 64 (47.8) | 77 (57.5) | 0.11§ |
| Baseline NIHSS, median (IQR) | 14 (11–15) | 12.5 (10–16) | 0.55† |
| Baseline ASPECTS and pc-ASPECTS | 7.5 (7–8) | 8 (7–8) | 0.24† |
| Time from onset-to-groin puncture, minute, median (IQR) | 327.5 (235.8–350) | 214 (175.8–270) | <0.001†* |
| Pure ICA occlusion, n (%) | 10 (7.4) | 10 (7.4) | 1§ |
| ICA plus M1 occlusion, n (%) | 34 (25.4) | 34 (25.4) | 1§ |
| M1 occlusion, n (%) | 61 (45.6) | 61 (45.6) | 1§ |
| M2 occlusion, n (%) | 16 (11.9) | 16 (11.9) | 1§ |
| BA occlusion, n (%) | 13 (9.7) | 13 (9.7) | 1§ |
| IVT, n (%) | 41 (30.6) | 63 (47.0) | 0.66§ |
| General anesthesia, n (%) | 85 (63.4) | 113 (84.3) | <0.001§* |
| Stent retriever alone technique, n (%) | 38 (28.4) | 38 (28.4) | 1§ |
| Stent retriever combined with aspiration, n (%) | 96 (71.6) | 96 (71.6) | 1§ |
| Angioplasty or acute stenting, n (%) | 28 (20.9) | 32 (23.9) | 0.73§ |
| Cardioembolism, n (%) | 85 (63.4) | 68 (50.7) | 0.04§* |
| Large-vessel atherosclerosis, n (%) | 45 (33.6) | 57 (42.5) | 0.13§ |
| In-hospital serve adverse event, n (%) | 21 (15.7) | 31 (23.1) | 0.06§ |
IQR, interquartile range; NIHSS, National Institutes of Health Stroke Scale; ASPECTS, Alberta Stroke Program Early Computed Tomography Score; pc-ASPECTS, posterior circulation-ASPECTS; ICA, internal carotid artery; BA, basilar artery; IVT, intravenous thrombolysis.
p was calculated using the chi-square test; §p was calculated using the Mann–Whitney U test.
*p < 0.05.
Comparison of overall outcomes
While the overall rate of successful reperfusion (mTICI 2b–3) did not differ significantly between groups, the Solitaire group achieved a significantly higher first-pass recanalization rate (p = 0.03) and required fewer device passes (p < 0.001) (Table 3). After adjusting for residual imbalances in IVT, onset-to-groin puncture time, and cardioembolism etiology, the odds of achieving first-pass recanalization were higher in the Solitaire group compared to the Tigertriever group (adjusted odds ratio (OR) = 1.82, 95% CI: 1.02–3.23, p = 0.04) with fewer device passes (adjusted OR = 0.19, 95% CI: 0.06–0.56, p = 0.002).
Table 3.
Comparison of patient outcomes.
| Tigertriever (n = 134) | Solitaire X (n = 134) | p-Value | |
|---|---|---|---|
| Successful recanalization (mTICI 2b-3), n (%) | 113 (84.3) | 105 (78.4) | 0.21§ |
| First-pass recanalization, n (%) | 54 (40.3) | 65 (48.5) | 0.03§* |
| Recanalization time, min (IQR) | 35 (20.8–60.0) | 35 (25.0–60.0) | 0.24† |
| Number of passages, median (IQR) | 2 (1–3) | 1 (1–2) | <0.001†* |
| Dissection or perforation complication, n (%) | 8 (6.0) | 4 (3.0) | 0.20§ |
| Thrombus migration, n (%) | 12 (9.0) | 16 (11.9) | 0.43§ |
| sICH, n (%) | 15 (11.2) | 7 (5.2) | 0.29§ |
| mRS at 90 days, median (IQR) | 2 (1–4) | 2 (1–3) | 0.10§ |
| Good outcome (mRS 0–2), n (%) | 72 (53.7) | 78 (58.2) | 0.46§ |
| Mortality, n (%) | 14 (10.4) | 10 (7.5) | 0.35§ |
mTICI, modified treatment in cerebral infarction; IQR, interquartile range; sICH, symptomatic intracranial hemorrhage; mRS, modified Rankin Scale.
p was calculated using the chi-square test; §p was calculated using the Mann–Whitney U test.
*p < 0.05.
At 3-month follow-up, functional outcomes as measured by the mRS were comparable between the two groups, with no statistically significant differences observed (Table 3). After adjusting for residual imbalances, the odds of achieving good functional outcome (mRS 0–2) were still not statistical significance (adjusted OR = 1.51, 95% CI: 0.87–2.61, p = 0.14).
Subgroup analysis of atherosclerotic occlusion
In patients with LVO due to intracranial atherosclerosis, baseline characteristics were broadly comparable between the two groups, except for notable differences in time from symptom onset to groin puncture, prevalence of BA occlusion, and use of general anesthesia (Table 4).
Table 4.
Subgroup analysis on atherosclerotic occlusion group.
| Tigertriever (n = 45) | Solitaire (n = 57) | p-Value | |
|---|---|---|---|
| Age, year, median (IQR) | 70 (62.5–76.0) | 67 (60.5–76.5) | 0.68† |
| Sex, male, n (%) | 24 (53.3) | 38 (66.7) | 0.17§ |
| Baseline NIHSS, median (IQR) | 14 (11–15) | 12 (10–16) | 0.24† |
| Baseline ASPECTS and pc-ASPECTS | 7 (7–8) | 8 (7–8) | 0.14† |
| Time from onset-to-groin puncture, min, median (IQR) | 300 (265–350) | 225 (172.5–270) | <0.001†* |
| ICA occlusion, n (%) | 18 (40) | 21 (36.8) | 0.75§ |
| M1 occlusion, n (%) | 19 (42.2) | 27 (47.4) | 0.61§ |
| M2 occlusion, n (%) | 4 (8.9) | 9 (15.8) | 0.30§ |
| BA occlusion, n (%) | 5 (11.1) | 0 (0) | 0.01§* |
| IVT, n (%) | 10 (22.2) | 29 (50.9) | 0.08§ |
| General anesthesia, n (%) | 28 (62.2) | 53 (93.0) | <0.001§* |
| Angioplasty or acute stenting, n (%) | 10 (22.2) | 7 (12.3) | 0.18§ |
| Periprocedural antithrombotic therapy, n (%) | 15 (33.3) | 16 (28.1) | 0.55§ |
| In-hospital serve adverse event, n (%) | 7 (15.6) | 11 (19.3) | 0.60§ |
| Successful recanalization (mTICI 2b–3), n (%) | 37 (82.2) | 42 (73.7) | 0.31§ |
| Non-recanalization (mTICI 0), n (%) | 0 (0) | 5 (8.8) | 0.04§* |
| Recanalization time, min (IQR) | 50 (30.0–74.5) | 47 (30.0–79.5) | 0.37† |
| Dissection or perforation complication, n (%) | 4 (8.9) | 2 (3.5) | 0.23§ |
| Thrombus migration, n (%) | 8 (17.8) | 1 (1.8) | <0.001§* |
| sICH, n (%) | 7 (15.6) | 2 (3.5) | 0.03§* |
| mRS at 90 days, median (IQR) | 2 (1–4) | 3 (1–4) | 0.35§ |
| Good outcome (mRS 0–2), n (%) | 25 (55.6) | 24 (42.1) | 0.46§ |
| Mortality, n (%) | 7 (15.6) | 7 (12.3) | 0.64§ |
IQR, interquartile range; NIHSS, National Institutes of Health Stroke Scale; ASPECTS, Alberta Stroke Program Early Computed Tomography Score; pc-ASPECTS, posterior circulation-ASPECTS; ICA, internal carotid artery; BA, basilar artery; IVT, intravenous thrombolysis; mTICI, modified treatment in cerebral infarction; sICH, symptomatic intracranial hemorrhage; mRS, modified Rankin Scale.
p was calculated using the chi-square test; §p was calculated using the Mann–Whitney U test.
*p < 0.05.
Although the difference was not statistically significant, a higher proportion of patients in the Tigertriever group achieved favorable functional outcomes (mRS 0–2 at 3 months) compared to the Solitaire group (55.6 vs. 42.1%, p = 0.46; adjusted OR = 1.35, 95% CI: 0.10–17.77, p = 0.82). The rate of failed recanalization was significantly lower in the Tigertriever group in unadjusted analysis (0 vs. 8.8%, p = 0.04); however, this difference did not remain statistically significant after adjustment for residual confounders (adjusted OR = 0.69, 95% CI: 0.02–19.62, p = 0.83). Similarly, unadjusted analyses showed significantly higher rates of thrombus migration (17.8 vs. 1.8%, p < 0.001) and symptomatic intracranial hemorrhage (15.6 vs. 3.5%, p = 0.03) in the Tigertriever group. However, these associations were no longer statistically significant after adjustment for baseline differences (adjusted OR for thrombus migration = 0.62, 95% CI: 0.01–34.24, p = 0.82; adjusted OR for symptomatic intracranial hemorrhage = 0.28, 95% CI: 0.01–1.04, p = 0.75).
These findings suggest that the observed crude differences may have been confounded by baseline imbalances, and caution is warranted when attributing these effects directly to the device itself.
Discussion
This matched-pair study compared procedural and clinical outcomes of MT with Tigertriever and Solitaire X. The Tigertriever showed lower first-pass recanalization rates and required more passes. However, in subgroups presenting with atherosclerotic occlusions, it showed a trend toward higher first-pass recanalization and successful reperfusion rates, as well as improved clinical outcomes. Overall, no significant difference in 3-month functional outcomes was found between the devices.
Interestingly, our findings diverge from previous reports by Piasecki et al. and Shindo et al., which indicated a significantly better first-pass effect (FPE) with the Tigertriever.7,8
Two factors may explain this inconsistency. First, the rate of cardioembolic stroke was significantly higher in the Tigertriever group (63.4 vs. 50.7%, p = 0.04), and nearly one-quarter of occlusions involved the ICA plus M1 segment, implying a longer thrombus burden. The mechanical characteristics of each device likely influenced their performance in this context. The Solitaire X delivers its strongest traction in the distal two-thirds of the stent, where aspiration support is most effective (Figure 2), potentially contributing to the improved FPE reported in recent study. 15 In contrast, the Tigertriever provides optimal traction in the proximal and mid portions. Given that combination techniques using aspiration tubing were employed in more than two-thirds of cases (Table 2), the Solitaire may have benefited more from this adjunctive force, especially when retrieving long cardioembolic thrombi. Second, the Solitaire's self-expanding design, with a median deployment time of 2–4 min, is well integrated into standard clinical practice and familiar to most interventionalists—particularly in institutions like ours with nearly a decade of experience. 16 Conversely, the Tigertriever's manually expandable design is more operator-dependent and requires a nuanced deployment strategy, such as the “FLEX” approach (fast controlled expansion with relaxation), to optimize thrombus engagement. 5
Figure 2.
Case of high-burden cardioembolic stroke treated with Solitaire X. (a) Solitaire X 4 × 20 mm device. (b–d) 70-year-old male presented with NIHSS 12 and ASPECTS 9 (ischemic lesion in the left posterior internal capsule) due to left ICA and middle cerebral artery (MCA) occlusion. (e) Thrombectomy alone within 6 h of onset confirmed left ICA terminus and MCA occlusion. (f) Solitaire X 4 × 20 in M1 with JET 7 reperfusion catheter in ICA. (g, h) First-pass recanalization with large thrombus retrieved. (i) Follow-up MRA at 24 h with sustained patency and without core expansion. NIHSS improved to 6; mRS 2 at 90 days. NIHSS, National Institutes of Health Stroke Scale; ASPECTS, Alberta Stroke Program Early Computed Tomography Score; ICA, internal carotid artery; mRS, modified Rankin Scale.
Despite these limitations in overall first-pass performance, the Tigertriever showed notable advantages in specific scenarios. In cases with a lower thrombus burden—particularly in patients with atherosclerotic intracranial stenosis—the Tigertriever demonstrated a trend toward superior performance. Baek et al. reported that recanalization with Solitaire alone in stenosis-related occlusions was only 28.9%, with rescue therapy needed in 84.3% of cases. 17 In contrast, Ojeda et al. achieved a 78% recanalization rate with the Tigertriever without additional interventions. 4 Our findings in a similar subgroup (n = 45) showed an mTICI 2b–3 rate of 82.2%, with only 22.2% requiring rescue therapy, and a 55.6% rate of good outcomes—closely aligning with Ojeda et al.'s study. 4 Unlike the Solitaire X, the Tigertriever allows the operator to actively expand the device to a larger diameter and then instantly reduce it, thanks to its adjustable radial force (Figure 1). This feature enables it to mimic balloon angioplasty effect and mechanically dilate stenotic segments (Figure 3). This technical feature may offer advantages in treating re-occlusion after thrombectomy. In such cases, angioplasty remains the preferred initial approach before considering acute stent placement, as demonstrated in multiple previous studies.18,19 Moreover, this finding may indicate superior thrombus-capturing ability of the Tigertriever in cases involving firm, platelet-rich clots commonly seen in atherosclerotic occlusions. However, it should be noted that these subgroup analyses were based on small sample sizes with wide CIs (3-month good outcome: 55.6% with Tigertriever vs. 42.1% with Solitaire X; adjusted OR = 1.35, 95% CI: 0.10–17.77, p = 0.82), which limits the interpretability of these findings.
Figure 3.
Case of large-artery atherosclerosis treated with Tigertriever 21. A 65-year-old woman with NIHSS 12 and ASPECTS 7 due to right M1 occlusion (a–c). (d) Digital subtraction angiography (DSA) confirms occlusion with moderate collaterals. (e) Tigertriever 21 deployed with four-notch expansion. (f) First-pass recanalization with residual stenosis. (g) Three successive six-notch stent-angioplasties plus 324 mg intragastric aspirin; no re-occlusion at 10 min. (h) Follow-up MRA at 16 h confirms patency. NIHSS improved to 8; mRS 2 at 90 days. NIHSS, National Institutes of Health Stroke Scale; ASPECTS, Alberta Stroke Program Early Computed Tomography Score; mRS, modified Rankin Scale.
Overall, no statistically significant differences in 3-month outcomes were observed between the Tigertriever and Solitaire X groups across anterior and posterior circulation strokes. Our findings support previous evidence from anterior circulation thrombectomy studies,6–8 while also expanding the evidence base by evaluating the Tigertriever's performance in posterior circulation, which has not been thoroughly explored in earlier studies. This broader inclusion provides a more comprehensive understanding of the device's real-world applicability across different stroke territories.
Several limitations should be acknowledged. As Solitaire X was predominantly used earlier in the study period and Tigertriever later, a potential temporal bias must be acknowledged, in addition to the retrospective, single-center design that introduces inherent selection biases and limits the generalizability of our results. Additionally, the relatively small sample size, particularly in subgroup analyses, may have limited statistical power to detect meaningful differences. Only patients treated within 6 h of stroke onset were included, thereby limiting the generalizability of the findings to late-window populations. To validate and expand upon our findings, future prospective, multicenter studies with larger cohorts and uniform procedural standards are warranted.
Conclusions
In this matched-pair retrospective study, the Tigertriever was associated with lower first-pass recanalization rates and a greater number of passes needed to achieve successful reperfusion. Nonetheless, in specific subgroups—particularly those presenting with atherosclerotic occlusions—the Tigertriever exhibited a tendency toward higher first-pass recanalization and successful reperfusion rates, along with more favorable clinical outcomes. Overall, no significant difference in 3-month good functional outcomes was observed between the two devices in MT for both anterior and posterior circulation strokes.
Footnotes
ORCID iDs: Huu An Nguyen https://orcid.org/0000-0002-5258-7259
Cuong Tran https://orcid.org/0009-0001-7081-7046
Hoang Khoe Le https://orcid.org/0000-0002-5908-0733
Laurent Pierot https://orcid.org/0000-0002-2523-4909
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Supplemental material: Supplemental material for this article is available online.
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