Complications of Endovascular Treatment for Acute Stroke in the SWIFT Trial with Solitaire and Merci Devices

Abstract

BACKGROUND AND PURPOSE: Treatment of patients with ischemic stroke after endovascular treatment requires in-depth knowledge of complications. The goal of this study was to make endovascular treatment for acute ischemic stroke safer through an in-depth review of the major periprocedural complications observed in the Solitaire FR With Intention for Thrombectomy (SWIFT) trial.

Iatrogenic Vessel Dissection in Endovascular Treatment of Acute Ischemic Stroke

“…intra-arterial thrombolysis, MT or both) [5]. In the SWIFT trial, ID was observed in 5 (3.5%) of the 144 patients treated with MT (Merci ® and Solitaire ® devices) [16]. These numbers are in line with the ID frequency of 2% (18/866) overall and 3.4% (18/524) seen in MT patients in our study.…”

“…The ID did not have a significant impact on clinical outcome compared to patients without ID despite severe complications possibly related to ID in 2 patients. To date, arterial dissection as a complication of endovascular AIS treatment has been systematically reported by the MR CLEAN, REVASCAT, SWIFT and STAR investigators [5,9,16,17]. Dissection occurred in 1% of STAR patients and 3.9% of REVASCAT patients as a complication of AIS treatment with either Solitaire ® (Medtronic, Dublin, Ireland) flow restoration thrombectomy or combined with medical management alone [9,17].…”

“…During the waiting period of 15-30 min, a microwire with the tip in the true lumen distal to the ID secured rapid access and stenting in the case of an increase of the false lumen and subsequent complete occlusion of the artery. Similarly, therapy in the five SWIFT ID patients consisted of conservative management in three, and stent placement and balloon angioplasty in one each [16]. The rationale for choosing the different treatment modes, recanalization rates and patient outcomes was not reported.…”

“…Studies reporting ID rates during cerebral angiography mainly include diagnostic angiography only [10][11][12] or interventional angiography for indications other than AIS, often in an elective, non-urgent setting [13][14][15]. Only a few studies have reported complication rates in endovascular AIS treatment (ranging from 1.7% to 3.9%), but clinical characteristics, risk factors, outcomes and morphological descriptions are lacking [5,9,16,17]. We aimed to assess the localization and morphology of ID, the clinical characteristics and risk factors for ID and outcomes in patients suffering from ID.…”

Double Solitaire Mechanical Thrombectomy in Acute Stroke: Effective Rescue Strategy for Refractory Artery Occlusions?

“…These included 5 patients treated for MCA M1 occlusion; 3, for ICAT occlusion; and 2, for ICA tandem occlusion, which overall represented 4.3% of all patients undergoing anterior circulation MT procedures during the analyzed time (see above). The median baseline NIHSS score was 16 (interquartile range, [13][14][15][16][17][18][19], and the median time from symptom onset to the start of the MT procedure was 168 minutes (interquartile range, 150 -179 minutes). For both ICA tandem occlusions, proximal ICA stent placement was performed before MT.…”