Rescue, Combined, and Stand-Alone Thrombectomy in the Management of Large Vessel Occlusion Stroke Using the Solitaire Device: A Prospective 50-Patient Single-Center Study

Abstract

Background and Purpose-Large vessel occlusion in ischemic stroke is associated with a high degree of morbidity. When intravenous thrombolysis fails, mechanical thrombectomy can provide an alternative and synergistic method for flow restoration. In this study we evaluate the safety and efficacy of our stroke management protocol (RECOST study). Methods-Fifty consecutive ischemic stroke patients with large vessel occlusion were included. After clinical and MRI imaging assessment, 3 treatment strategies were selected according to time of symptom onset and location of vessel occlusion: rescue therapy; combined therapy; and stand-alone thrombectomy (RECOST study). MRI ASPECT score Ͻ5 was the main exclusion criterion. Mechanical thrombectomy was performed exclusively with the Solitaire flow restoration device. Clinical outcome was assessed after treatment, on day 1, and at discharge. Results-Mean patient age was 67.6 years, mean NIHSS score was 14.7, and mean ASPECT score was 6 on presentation.Vessel occlusions were in the middle cerebral artery (40%), the internal carotid artery (28%), and the basilar artery (32%). Rescue treatment represented 24%, combined therapy represented 56%, and stand-alone thrombectomy represented 20%. Mean recanalization time from symptoms onset was 377 minutes, with overall recanalization rate TICI 3 of 84%. NIHSS score at discharge was 6.5, with 60% of patients demonstrating NIHSS score 0 to 1 or an improvement of Ͼ9 points. Symptomatic complication rate was 10%. At 3 months, 54% of patients had a modififed Rankin scale score of 0 to 2, with an overall mortality rate of 12%. Conclusions-The present integrated stroke management protocol (RECOST study) demonstrated rapid, safe, and effective recanalization. We postulate that the Solitaire device contributed to high recanalization and patient selection using MRI ASPECT score to low and complication rates, therefore avoiding futile and dangerous interventions. (Stroke.

Intra-arterial Therapy for Acute Ischemic Stroke

“…Recanalization efficacy has varied between 80 to 100% with a symptomatic ICH rate of approximately 10%. Most of the patients treated did not need adjunctive thrombolysis, although in the study by Costalat et al [78] many patients received thrombolysis. Several manufacturers have developed stentrievers that are in the various stages of testing, although none are commercially available in the United States yet.…”

“…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%.…”

Technical Feasibility and Application of Mechanical Thrombectomy with the Solitaire FR Revascularization Device in Acute Basilar Artery Occlusion

“…10 However, most studies concerning the efficacy of stent retrievers have been performed in large vessel occlusions of the anterior circulation, including only a few or single cases of BAO. [10][11][12][13][14][15][16][17] Furthermore, in the posterior circulation, proximal balloon occlusion for flow reversal during retrieval is not applicable. Therefore, the risk of distal thromboembolic events is potentially increased.…”

Evaluation of an Intravenous-Endovascular Strategy in Patients with Acute Proximal Middle Cerebral Artery Occlusion

“…Pacemaker and patient agitation were the main MRA contraindications. After a review of our therapeutic strategy in September 2009, 13 eligible patients were then split into 2 groups: 1) Patients from the first study period (January 2007 to August 2009, 32 months) treated with standard IVT alone were registered in the IVT group, and 2) patients from the second study period (September 2009 to September 2010, 12 months) treated by using the IES were registered in the IES group. The IES group included patients who received either a rescue thrombectomy following IVT failure or a successful IVT.…”