Successful Mechanical Thrombectomy Rescue with the NeVa Stent Retriever: Efficacy and Risks of a Novel Hybrid Multifunctional Zones Device

The NeVa (Vesalio) thrombectomy device is a CE-approved novel hybrid-cell stent retriever with offset enlarged openings coupled to functional zones, a closed distal end, and a relatively high radial force compared with traditional stent retrievers. This new generation device was designed to incorporate and trap resistant emboli. We present the case of an 80-year-old woman with a past medical history of arterial hypertension and atrial fibrillation treated with low molecular-weight heparin. She had a mild-to-moderate disability due to a left-hemispheric stroke 2 years before the current admission. The patient was admitted to the hospital with a National Institutes of Health Stroke Score (NIHSS) of 23 after awakening with signs and symptoms of a major left-hemispheric stroke. She had been well 3 h prior to admission. She was diagnosed with SARS-COV-2 infection upon admission. Noncontrast cranial CT did not reveal acute ischemic lesions. CT angiography showed tandem embolic occlusions of the midcervical segment of the left internal carotid artery (ICA) and the dominant frontal trunk of the left middle cerebral artery (MCA) in the proximal M2 segment. CT perfusion (CTP) confirmed a sizeable area of hypoperfusion in the left hemisphere. The patient underwent a successful and uneventful endovascular revascularization of the tandem left ICA-MCA (M2) occlusion using a novel hybrid stent retriever. A moderate neurological improvement was observed immediately after extubation, with a postprocedure NIHSS of 15. Postprocedure head CT revealed an ischemic stroke in the region supplied by the left MCA, without signs of hemorrhagic transformation (Alberta Stroke Program Early CT Score [ASPECTS] 5). Anticoagulation with enoxaparin was initiated 24 h after the procedure, and the patient was discharged to rehabilitation after 14 days with an NIHSS of 13 and a modified Rankin Scale (mRS) score of 4. The use of the multifunctional stent retrievers for the treatment of large vessel occlusions (LVO) caused by resistant clots refractory to the standard devices is the main topic of this chapter.