Abstract 228: Initial Multicenter Experience with the Tigertriever 17 as a First‐Line Device for Mechanical Thrombectomy in Distal Medium Vessel Occlusions

Introduction/Purpose Mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVO) in acute ischemic stroke (AIS) remains technically challenging, and robust evidence for dedicated devices is limited. The Tigertriever 17 is a manually expandable stent retriever designed for small‐caliber, tortuous intracranial vessels. This study aimed to evaluate its safety and effectiveness when used as a first‐line device for MT in DMVO. Materials/Methods This is a retrospective, multicenter observational study of patients with AIS due to DMVO treated between January 2024 and May 2025 using the Tigertriever 17 as a first‐line device for mechanical thrombectomy. Data were collected from two high‐volume stroke centers in Germany. This abstract presents an interim analysis of the currently available cases. Inclusion required the presence of a neurological deficit and radiological evidence of DMVO. The primary endpoint was successful reperfusion (mTICI ≥2b). Secondary endpoints included symptomatic and non‐symptomatic intracranial hemorrhages. Subgroup analyses were performed for patients treated with co‐aspiration and those with M2/M3 occlusions. Results A total of 45 patients were included in this interim analysis. ‐ The overall reperfusion rate among all patients with available outcome data was 84.4% (38/45). ‐ In the co‐aspiration subgroup (n=41), successful reperfusion was achieved in 87.8% (36/41). ‐ Among the 39 patients with occlusions in the M2‐M3 segments of the middle cerebral artery treated with co‐aspiration, who represented the majority of the cohort, the reperfusion rate was 87.2% (34/39). ‐ Rescue maneuvers using alternative thrombectomy devices were performed in 7 cases, resulting in successful reperfusion in 5 of them. ‐ No symptomatic intracranial hemorrhages were observed. Four non‐symptomatic hemorrhages occurred, three of which were unrelated to the device, and one with unclear association. Conclusion This interim multicenter analysis suggests that the Tigertriever 17, when used as a first‐line device, is a safe and effective tool for mechanical thrombectomy in DMVO. Particularly in combination with co‐aspiration techniques, the reperfusion rates exceeded historical benchmarks of 75%, reaching nearly 88% in targeted subgroups. These findings support the use of the Tigertriever 17 in small vessel occlusions and warrant confirmation through prospective studies. Full data from all participating centers will be included in the final analysis.