A59 Advancing beyond recent RCTs: the role of TIGERTRIVER 13 in endovascular treatment for distal medium-vessel occlusion

<h3>Introduction</h3> Mechanical thrombectomy (MT) has improved revascularization rates and outcomes for acute ischemic stroke (AIS). While MT is standard for proximal large vessel occlusions (PLVOs), its role in distal medium vessel occlusions (DMVOs), remained unclear until recently following three RCTs. Intravenous thrombolysis (IVT) is the primary treatment but fails in 50–66% of cases. Recent low-profile stent retrievers have enhanced distal access. We present our experience with the smallest dedicated thrombectomy device for DMVO, Tigertriever13. <h3>Aim of Study</h3> To assess the safety and efficacy of Tigertriever13 for MT in DMVO, comparing outcomes to recent RCTs. <h3>Method</h3> We performed a retrospective analysis of all consecutive AIS patients who underwent thrombectomy with Tigertriever13 for DMVO. Patient’s characteristics were analyzed as well as procedural complications, angiographic and clinical outcome. <h3>Results</h3> Our cohort included 43 patients (median age 71); 37.2% received IV lytics before MT. Subgroups: (1) primary DMVO (17/43, 39.5%), (2) secondary DMVO post-LVO (19/43, 44.2%), and (3) DMVO related to non-stroke endovascular procedures (7/43, 16.2%). Successful recanalization was achieved in 86.0% (37/43). No symptomatic ICH occurred. At 90 days, median mRS was 3 (IQR 2–5), with 39.5% (17/43) achieving mRS ≤2. Mortality was 11.8% in primary and 10.5% in secondary DMVO. Compared to RCTs, recanalization rates were higher (86% vs. 71–75%), with no sICH (0% vs. 5.4–5.9%), and mortality was comparable (16.3% vs. 13.3–15.5%). <h3>Conclusion</h3> Tigertriever13 appears safe and effective for DMVO. Outcomes and complications align with PLVO trials. Further RCT studies are needed to optimize strategies for MT in DMVO. <h3>Conflict of Interest</h3> No