Initial experience with a self-expanding retrievable stent for recanalization of large vessel occlusions in acute ischemic stroke

Menon, Bijoy K; Kochar, Puneet; Ah-Seng, Andrew C.; Almekhlafi, Mohammed; Modi, Jayesh; Wong, John H.; Hudon, Mark E.; Morrish, W; Demchuk, Andrew M.; Goyal, Mayank

doi:10.1007/s00234-010-0835-x

Cited by 33 publications

(26 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[1][2][3][4][5] This improvement is reflected in better clinical outcome in studies such as Solitaire With the Intention for Thrombectomy (SWIFT), Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke (TREVO)-2, and Solitaire FR Thrombectomy for Acute Revascularization (STAR). [6][7][8][9] This enthusiasm for newer mechanical devices is tempered by results of Interventional Management of Stroke (IMS) 3, Synthesis Expansion: A Randomized Controlled Trial on Intra-Arterial Versus Intravenous Thrombolysis in Acute Ischemic Stroke (SYNTHESIS), and Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR Rescue) that demonstrate no added advantage of endovascular therapy compared with intravenous tissue-type plasminogen activator (tPA).…”

mentioning

confidence: 99%

Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke

Menon

Almekhlafi

Pereira

et al. 2014

Stroke

Self Cite

143

View full text Add to dashboard Cite

Background and Purpose-We report on workflow and process-based performance measures and their effect on clinical outcome in Solitaire FR Thrombectomy for Acute Revascularization (STAR), a multicenter, prospective, single-arm study of Solitaire FR thrombectomy in large vessel anterior circulation stroke patients. Methods-Two hundred two patients were enrolled across 14 centers in Europe, Canada, and Australia. The following time intervals were measured: stroke onset to hospital arrival, hospital arrival to baseline imaging, baseline imaging to groin puncture, groin puncture to first stent deployment, and first stent deployment to reperfusion. Effects of time of day, general anesthesia use, and multimodal imaging on workflow were evaluated. Patient characteristics and workflow processes associated with prolonged interval times and good clinical outcome (90-day modified Rankin score, 0-2) were analyzed. Results-Median times were onset of stroke to hospital arrival, 123 minutes (interquartile range, 163 minutes); hospital arrival to thrombolysis in cerebral infarction (TICI) 2b/3 or final digital subtraction angiography, 133 minutes (interquartile range, 99 minutes); and baseline imaging to groin puncture, 86 minutes (interquartile range, 24 minutes). Time from baseline imaging to puncture was prolonged in patients receiving intravenous tissue-type plasminogen activator (32-minute mean delay) and when magnetic resonance-based imaging at baseline was used (18-minute mean delay). Extracranial carotid disease delayed puncture to first stent deployment time on average by 25 minutes. For each 1-hour increase in stroke onset to final digital subtraction angiography (or TICI 2b/3) time, odds of good clinical outcome decreased by 38%. Conclusions-Interval times in the STAR study reflect current intra-arterial therapy for patients with acute ischemic stroke.Improving workflow metrics can further improve clinical outcome. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01327989.

show abstract

mentioning

confidence: 99%

Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke

Menon

Almekhlafi

Pereira

et al. 2014

Stroke

Self Cite

143

View full text Add to dashboard Cite

show abstract

“…Mattle et al 42 reviewed three pilot studies with a total of 29 patients with BAO and reported at least 90% recanalization rate, 31% mortality rate and 45% favorable outcome (mRS 0 -2) among survivors. However, these trials differed in the proportional representation of BAO and pre-post-Solitaire TM treatment method and proportion [43][44][45] . In a recent study, Mordasini et al presented 14 consecutive patients with BAO treated with Solitaire TM with on demand addition of multimodal therapy approaches, such as for example thromboaspiration, IV and/or IA thrombolysis, and percutaneous transluminal angioplasty/permanent stent placement 45 .…”

Section: Mechanical Thrombectomymentioning

confidence: 99%

“…However, these trials differed in the proportional representation of BAO and pre-post-Solitaire TM treatment method and proportion [43][44][45] . In a recent study, Mordasini et al presented 14 consecutive patients with BAO treated with Solitaire TM with on demand addition of multimodal therapy approaches, such as for example thromboaspiration, IV and/or IA thrombolysis, and percutaneous transluminal angioplasty/permanent stent placement 45 . At 3 months, good functional outcome (mRS 0 -2) was observed in 28.6% (4/14) patients and overall mortality was 35.7% (5/14).…”

Section: Mechanical Thrombectomymentioning

confidence: 99%

“…At 3 months, good functional outcome (mRS 0 -2) was observed in 28.6% (4/14) patients and overall mortality was 35.7% (5/14). Hemorrhagic complications were referred in up to 3% of BAO patients undergoing mechanical clot extraction [43][44][45][46][47] . Although Solitaire TM may be used as the first line treatment, difficult situations can arise subsequently requiring additional procedures such as permanent stent or balloon angioplasty 46,48 .…”

Section: Mechanical Thrombectomymentioning

confidence: 99%

See 1 more Smart Citation

Management of acute basilar artery occlusion: Should any treatment strategy prevail?

Dorňák

Herzig²,

Šaňák³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

View full text Add to dashboard Cite

Background. Acute basilar artery occlusion (BAO) is relatively infrequent form of acute ischemic stroke associated with severe and persisting neurological deficit and high mortality rate (to 86%). Early recanalization is essential for good clinical outcome but the most effective treatment approach remains unestablished. Several treatment strategies are currently available but their safety and efficacy have only been tested in retrospective/prospective case series. Randomized controlled trials (RCTs) are lacking. Methods and Results. We searched the PubMed database for assessments of recanalization rate and clinical outcome in BAO patients treated with various treatment methods. The results show that antithrombotics are least effective while specific reperfusion therapies including intravenous thrombolysis (IVT) and various types of intra-arterial therapy (IAT) are more so. Less than half of BAO patients reach independent outcome following IVT with a recanalization rate 52 -78%. Even though IAT recanalizes BAO more frequently (in up to 100%), the higher recanalization rate is not necessarily associated with better outcome. Conclusions. Good clinical outcome is strongly dependent on recanalization time. Thus, the concept of bridging therapy, combining widely available IVT with IAT, was introduced and is usually considered a rescue strategy in nonresponders to IV alteplase. A trend to better outcome in patients treated with bridging therapy in some studies, has to be confirmed by large RCTs.

show abstract

“…[23][24][25][26][27][28][29][30][33][34][35][36][37][38][39][40][41][42][43][44][45][46] If we summarize the data from the studies listed in the table, the average recanalization rate is 93.3% to achieve a TICI 2-3/TIMI 2-3 score in a mean of 1.8 passes. Favorable outcome, as measured by mRS score of 0 -2, was achieved in 49.2% of patients at 90 days, with an average mortality rate of about 17.4%.…”

mentioning

confidence: 99%

Retrievable stents, “stentrievers,” for endovascular acute ischemic stroke therapy

et al. 2012

View full text Add to dashboard Cite

Endovascular therapy for acute ischemic stroke continues to evolve to improve both efficacy and safety. In the late 1990s, intra-arterial chemical thrombolysis with prourokinase was shown to be effective in achieving partial recanalization and improving clinical outcome, in comparison with intra-arterial heparin administration. However, this was at the expense of an increase in the rate of symptomatic intracranial hemorrhage to 10%. To improve the rate of recanalization, expand the time window, and reduce the risk of symptomatic intracranial hemorrhage, mechanical thrombectomy was introduced, with initial approval of the Merci clot retriever, a corkscrew-like device, and then more recently with approval of the Penumbra thromboaspiration system. Both devices are associated with a high rate of recanalization (total, partial, and complete). However, time to recanalization was on average 45 minutes, with a low rate of complete clot resolution, given that the majority of patients achieved only partial recanalization. More recently, retrievable stents have shown promise in reducing the time to recanalization, and they achieve a higher rate of complete clot resolution with improved feasibility. The retrievable stent can be opened within the clot to engage it within the stent struts, and subsequently it is retrieved by pulling it under flow arrest. The retrievable stents provide a new tool in the armamentarium of devices that can be used to achieve safe and timely clot removal. This review provides the historical evolution of endovascular therapy to use of stentreivers. Neurology ® 2012;79 (Suppl 1):S148-S157 GLOSSARY AIS ϭ acute ischemic stroke; CI ϭ confidence interval; ECASS ϭ European Cooperative Acute Stroke Study; FDA ϭ US Food and Drug Administration; IA ϭ intra-arterial; ICA ϭ internal carotid artery; ICH ϭ intracerebral hemorrhage; IMS ϭ Interventional Management of Stroke; MCA ϭ middle cerebral artery; mRS ϭ modified Rankin Scale; NIHSS ϭ NIH Stroke Scale; NINDS ϭ National Institute of Neurological Disorders and Stroke; OR ϭ odds ratio; PROACT ϭ Prolyse in Acute Cerebral Thromboembolism; RSs ϭ retrievable stents; rtPA ϭ recombinant tissue plasminogen activator; SESs ϭ self-expanding stents; SWIFT ‫؍‬ Solitaire FR With the Intention for Thrombectomy; TICI ϭ thrombolysis in cerebral ischemia; TIMI ϭ thrombolysis in myocardial infarction.Acute ischemic stroke (AIS) therapy is based on the concept that early recanalization of the occluded artery leads to improved clinical outcome through preservation of the time-sensitive penumbra.1-3 There has been an evolution in the development of techniques used to achieve faster and safer rates of recanalization. Because of the limited efficacy of pharmacologic thrombolysis, mechanical and multimodality methods have been sought to aid revascularization of the occluded artery. A newer endovascular approach using retrievable stents (RSs) shows promising results for better and faster rates of recanalization with possibly better shortterm outcomes.

show abstract

Initial experience with a self-expanding retrievable stent for recanalization of large vessel occlusions in acute ischemic stroke

Abstract: Use of a novel self-expanding, fully retrievable stent resulted in fast and very high recanalization rates in acute ischemic strokes with intravascular occlusions.

Cited by 33 publications

References 20 publications

Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke

Optimal Workflow and Process-Based Performance Measures for Endovascular Therapy in Acute Ischemic Stroke

Management of acute basilar artery occlusion: Should any treatment strategy prevail?

Retrievable stents, “stentrievers,” for endovascular acute ischemic stroke therapy

Contact Info

Product

Resources

About