Comparison of mechanical thrombectomy with Tigertriever versus Solitaire X stent retriever in real-world practice: A matched-pair retrospective analysis

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.