Background and PurposeStrokes secondary to acute internal carotid artery (ICA) occlusion are associated with extremely poor prognosis. Best treatment approach to acute stroke in this setting is unknown. We sought to determine clinical outcomes in patients with acute ischemic stroke due to ICA occlusion treated with intravenous (IV) systemic thrombolysis or intraarterial (IA) endovascular therapy.MethodsUsing the PubMed database we searched for studies that included patients with acute ischemic stroke due to ICA occlusion who had received treatment with IV thrombolysis or IA endovascular interventions. Studies that provided data on functional outcomes beyond 30 days, mortality and symptomatic intracerebral hemorrhage (sICH) rates were included in our analysis.ResultsWe identified 28 studies with a total of 385 patients in the IV thrombolysis group and 584 patients in the endovascular group. Rates of favorable outcomes and sICH were significantly higher in the endovascular group than in the IV thrombolysis-only group (33.6% vs 24.9%, p=0.004 and 11.1% vs 4.9%, p=0.001, respectively). No significant difference in mortality rates was found between the two groups (27.3% in the IV thrombolysis group vs 32.0% in the endovascular group, p=0.12).ConclusionsAccording to our systematic review, endovascular treatment of acute ICA occlusion results in improved clinical outcomes. A higher rate of sICH following endovascular treatment does not result in an increased overall mortality rate. Randomized trials comparing systemic thrombolysis vs endovascular treatment are needed to determine the best treatment strategy in patients with acute ICA occlusion.Competing interestsM Mokin: None. T Kass-Hout: Genentech. O Kass-Hout: None. T Dumont: None. P Kan: None. K Snyder: Toshiba and ev3. A Siddiqui: NINDS 1R01NS064592-01A1, University at Buffalo. Shurtleff, Inc., Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra. Codman & Shurtleff, Inc, Genentech. Hotspur, Intratech Medical, StimSox, Valor Medical. Abbott Vascular, American Association of Neurological Surgeons, Neocure Group LLC, an Emergency Medicine Conference, Abbott Vascular. E Levy: Codman & Shurtleff, Inc.,ev3/Covidien Vascular Therapies, Boston Scientific. TheraSyn Sensors, Inc. Medical Ltd., Mynx/Access Closure.

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Background The promising results of the Solitaire FR With the Intention for Thrombectomy (SWIFT) trial recently led to Food and Drug Administration (FDA) approval of the Solitaire FR stent retriever device for recanalisation of cerebral vessels in patients with acute ischaemic stroke. Objective To report the early postmarket experience with this device since its FDA approval in the United States, which has not been previously described. Methods We conducted a retrospective analysis of consecutive acute ischaemic strokes cases treated between March 2012 and July 2012 at 10 United States centres where the Solitaire FR used as a single device or in conjunction with other intraarterial endovascular approaches. Results A total of 101 patients were identified (mean age, 64.7 years; mean admission National Institutes of Health Stroke Scale [NIHSS] score, 17.6). Intravenous thrombolysis was administered in 39% of cases; other endovascular techniques were utilised in conjunction with the Solitaire FR in 52%. Successful recanalisation (Thrombolysis in Myocardial Infarction 2/3) was achieved in 88%. The rate of symptomatic intracranial haemorrhage within the first 24 hours was 15%. In-hospital mortality was 26%. At 30 days, 38% of patients had favourable functional outcome (modified Rankin scale score ≤2). Severity of NIHSS score on admission was a strong predictor of poor outcome. Conclusion Our study shows that a variety of other endovascular approaches are used in conjunction with Solitaire FR in actual practice in the United States. Early postmarket results suggest that Solitaire FR is an effective tool for endovascular treatment of acute ischaemic stroke. Disclosures M. Mokin: 1; C; Toshiba Educational Research Grant. T. Dumont: None. E. Veznedaroglu: None. M. Binning: None. K. Liebman: None. R. Fessler: None. C. Yuen To: None. R. Turner: None. A. Turk: None. I. Chaudry: 2; C; ev3/Covidien, Microvention. A. Arthur: 2; C; Covidien, J&J, Stryker, Terumo. B. Fox: None. R. Hanel: None. R. Tawk: None. P. Kan: None. G. Lanzino: None. D. Lopes: None. M. Chen: None. R. Moftakhar: None. J. Billingsley: None. A. Ringer: 2; C; ev3/Covidien, Stryker. K. Snyder: 2; C; Toshiba. 3; C; ev3/Covidien, The Stroke Group. N. Hopkins: 2; C; Abbott, Boston Scientific, Cordis, Micrus, W. L. Gore. 3; C; Abbott Vascular. 6; C; St. Jude Medical, Toshiba, AccessClosure, Augmenix, Boston Scientific, Claret Medical, Micrus, Valor Medical, Boston Scientific, Cleveland Clinic, Complete Conference Management, Cordis, SCAI. A. Siddiqui: 2; C; Codman & Shurtleff, Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra. 3; C; Codman & Shurtleff, Genentech. 6; C; Hotspur, Intratech Medical, StimSox, Valor Medical. E. Levy: 1; C; Boston Schientific, Codman & Shurtleff, ev3/Covidien Vascular Therapies. 2; C; Codman & Shurtleff; ev3/Covidien Vascular Therapies, TheraSyn Sensors. 4; C; Intratech Medical, Mynx/Access Closure. 6; C; Abbott Vascular, ev3/Covidien Vascular Therapies.

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