Mechanical Thrombectomy With the Solitaire AB Device in Large Artery Occlusions of the Anterior Circulation

Abstract

Background and Purpose-To describe the safety and effectiveness of a self-expanding and fully retrievable stent (Solitaire AB; ev3 Inc, Plymouth, MN) in revascularization of patients with acute ischemic stroke. Methods-Prospective, single-center study of 20 patients with an acute ischemic stroke attributable to a large artery occlusion of the anterior circulation within the first 8 hours from symptoms onset (median National Institutes of Health Stroke Scale, 19 [interquartile range,[15][16][17][18][19][20][21][22][23]). The occlusion site was middle cerebral artery in 12 patients, proximal internal carotid artery/middle cerebral artery tandem occlusion in 3 patients, and terminus internal carotid artery in 5 patients. Thrombectomy was used as rescue therapy in 2 patients who were refractory to intra-arterial plasminogen activator, and in 3 patients in whom successful recanalization with the MERCI retriever was not achieved. Results-Successful revascularization defined as thrombosis in cerebral ischemia grade 2b or 3 was achieved in 18 of 20 (90%) treated vessels, and 16 patients showed immediate restoration of flow after stent deployment. The mean number of passes for maximal recanalization was 1.4, and the median (quartiles) time from groin puncture to recanalization was 50 (38 -71) minutes. No case required adjuvant therapy after deployment of the embolectomy device. No significant procedural events occurred. Symptomatic intracranial hemorrhage was found in 2 (10%) patients, 4 (20%) patients died during the 90-day follow-up period, and 45% of patients showed good functional outcome at 3 months (modified Rankin Scale score Յ2). Conclusions-These results suggest that the Solitaire AB device can rapidly, safely, and effectively retrieve clots from the middle cerebral artery and terminus internal carotid artery within 8 hours from symptoms onset. (Stroke. 2010;41:1836-1840.)Key Words: acute Ⅲ embolectomy Ⅲ interventional neuroradiology Ⅲ reperfusion Ⅲ stroke Ⅲ thrombectomy T he Solitaire AB (ev3 Inc, Plymouth, MN) is a selfexpanding stent that offers the unique capability of being able to be fully deployed and then completely retrieved if it has not been detached. 1,2 In this pilot study, we tested whether the Solitaire AB stent could be used as a novel mechanical embolectomy device for large artery occlusions of the anterior circulation in patients presenting within 8 hours from the onset of an acute ischemic stroke. Materials and MethodsWe treated 20 consecutive patients refractory or ineligible for the use of intravenous tissue plasminogen activator who met the following criteria: age 80 years or younger, National Institutes of Health Stroke Scale (NIHSS) score Ն8 or lower if there was a fluctuating neurological deficit, time from symptoms onset to the endovascular procedure of Ͻ8 hours, absence of large signs of ischemia (defined as an Alberta Stroke Program 3 early CT score of Ͻ7 or MR diffusion-weighted lesion Ͼ50% of the middle cerebral artery territory), and an angiographically proven occlusion of the ante...

Thrombectomy vs. Systemic Thrombolysis in Acute Embolic Stroke with High Clot Burden: A Retrospective Analysis

“…, which was the first positive RCT on intraarterial treatment against standard stroke treatment. Comparable results have been published by other retrospective trials using the Penumbra system (81.6 %, TIMI II-III) [10], the Solitaire device (90 %, 79 %) [11,12], the Revive ® device (100 %, n = 10) [13], the Trevo ® device (68 %, 39 %, 78.3 %) in three trials [6, 14, 15] and using the Trevo ® or Solitaire ® device (83.9 %, TICI 2a or 3) in the Abb. 2 Klinisches Ergebnis (mRS) bei Entlassung in der Thrombektomie-(Trevo) und Kontrollgruppe (Control).…”

Intra-arterial Therapy for Acute Ischemic Stroke

“…One intriguing quality is the ability of the interventionist to deploy the device as a stent, but then recapture it once the thrombus has been lysed, leaving nothing behind. To date, the published data include a small series and 2 prospective pilot trials of 20 and 50 patients each [75][76][77][78]. Recanalization efficacy has varied between 80 to 100% with a symptomatic ICH rate of approximately 10%.…”

Mechanical Thrombectomy in Basilar Artery Thrombosis: Technical Advances and Safety in a 10-Year Experience

“…The newest generation of MT devices are called ''stent retrievers'' [13][14][15]. Stent retrievers are self-expanding, fully retrievable, flexible, intracranial microstents [e.g., Solitaire (ev3 Endovasc.…”