Paper:
The NeVa stent-retriever – a single-centre, real-world experienceAuthors:
Pervinder Bhogal, Marco Mancuso-Marcello , Rory Fairhead, Katherine Parkin, Giovanna Klefti, Levansri Makalanda , Ken Wong, Joseph Lansley, Karthikeyan Vanchilingham, Michael Przyszlak, Rukhtam Saqib, Oliver Spooner
Journal:
Interventional Neuroradiology – MAY 2025Background:
Stent-retriever-based mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). First-pass effect (FPE) is one most powerful predictors of positive outcomes in LVO AIS patients treated with MT.Objective:
To evaluate the safety and effectiveness of revascularization of acute LVOs with the NeVa device.Methods:
We performed an independent central reader review of our prospectively maintained database to identify all patients treated first with the NeVa stent retriever at our single high-volume Comprehensive Stroke Centre between January 2021 and December 2024.
The inclusion criteria included:
- Age ≥18
- National Institutes of Health Stroke Scale (NIHSS) score >5
- ASPECT score ≥5
- LVO on CT angiography
- Pre-morbid mRS 0-2
- Life expectancy of >6 months
- The NeVa device was the first stent-retriever device attempted for the treatment of the identified intracranial occlusion
Results:
Patient Characteristics:
- Overall, 89 patients met our inclusion criteria.
- The median age was 73 yrs (range 28-88; 52% male).
- The median presentation NIHSS was 16 (range 5-30)
- 49% received IV tPA prior to MT.
- 93% of target occlusions were in the anterior circulation (n = 83)
- The median ASPECT score on plain CT was 8 (range 5-10)
Procedural Characteristics:
- A Balloon Guide Catheter (BGC) was used in 80% of cases and a distal aspiration catheter was used in all cases.
- Longer NeVa models (≥29 mm) were used in 89% of cases.
- The median number of passes when only NeVa was used was 1 (range 1–6) with the mean number of passes at 1.4
Procedural Results:
- First-pass and final recanalization outcomes are per the below table:
- Good functional outcome (mRS ≤2) was achieved in 40% of patients (n = 81).
- There were no device-related or intra-procedural serious adverse events.
Discussion:
- The first-pass recanalization performance of the NeVa device in the context of this series exceeds the reported performance of other strent-retreivers in the literature.
- Our first-pass TICI 2c-3 results in an unselected population are improved but comparable to the largest series to date:
- We believe that the combination of these factors may have led to a significantly higher FPE and mFPE in our cohort compared to previous studies:
- High rate of BGC use (79.8% of cases)
- Clot related factors (79.8% were hyperdense clots, ≈19 mm average clot length)
- Dwell time (5 min)
- Our functional independence at follow-up in the present study were lower in comparison to the NeVa CLEAR study. This could reflect the nature of this series as well as being caused by other non-device/ procedure-related factors such as poor access to rehabilitation.
a) A patient in their 70s presented with an NIHSS score of 6 and ASPECT score 9 After CTA confirmed an occlusion, the patient was transferred for mechanical thrombectomy
b) Initial angiography confirmed occlusion of the right mid-M1
c) A NeVa 4.0 × 30 mm was deployed for 5 minutes per our standard practice.
d) Angiography demonstrated eTICI 3 recanalization after the first pull
e) The 24-hour CT scan showed infarction within the basal ganglia (ASPECT score 8) with high density seen in the Sylvian fissure
f) with minimal sub-arachnoid haemorrhage seen on the virtual non-contrast spectral reconstruction
Conclusion:
The NeVa stent-retriever has a very high rate of FPE and final recanalization in this real-world cohort of patients from the NeVa One registry. These results are higher than those previously published and may support longer NeVa device use with a BGC and proximal aspiration to optimize FPE.
