Unwanted detachment of the Solitaire device during mechanical thrombectomy in acute ischemic stroke

Castaño, Carlos; Dorado, Laura; Remollo, Sebastià; García-Bermejo, Pablo; Gomis, Meritxell; Ossa, Natàlia Pérez de la; Millán, Mònica; García-Sort, M R; Hidalgo, Cristina; López‐Cancio, Elena; Cubells, Carles Luaces; Dávalos, Antoni

doi:10.1136/neurintsurg-2015-012156

Cited by 18 publications

(24 citation statements)

References 14 publications

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“…There are only a few reported cases of complications involving breakage and inadvertent device detachment during thrombectomy [4-8] with reported techniques describing retrieval of the detached stent [4, 7, 8]. To our knowledge, there has been no report on catheter breakage during neurovascular thrombectomy or techniques to safely retrieve it.…”

Section: Introductionmentioning

confidence: 86%

“…2) using ENSnare and microsnare devices, respectively. Snare devices have been previously used to retrieve stretched platinum coils [11] or detached stents [7]. Microsnares have also been used to retrieve Onyx-entombed catheters [5].…”

Section: Discussionmentioning

confidence: 99%

“…A multicenter case series estimated the rate of stent retriever detachment to be 0.66% in large-volume thrombectomy centers [8]. Snare devices [7, 8], manual aspiration [8], and a second mechanical thrombectomy device [4, 8] was used to remove the retained stent. Open surgical approach has also been used to remove detached stents [9, 10].…”

Section: Discussionmentioning

confidence: 99%

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Direct Aspiration Catheter Fracture and Retrieval during Neurothrombectomy

Moshayedi¹,

Jadhav²

2018

Intervent Neurol

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Background: Application of direct aspiration catheters has revolutionized acute stroke care and has led to significant improvement in clinical outcome with a good safety profile. Catheter fracture and retention is a rare but potentially devastating complication. Case Description: Here we present two cases of acute stroke complicated by aspiration catheter fracture and retention. Successful catheter retrieval and revascularization was achieved in both cases. The stenosis or tortuosity of vascular anatomy appears to be the probable contributor to catheter breakage by anchoring the catheter with resultant fracture at the constraint point from catheter withdrawal tensile stress. Conclusion: This report describes application of snare devices in retrieving a broken catheter during thrombectomy in the anterior and posterior circulation, and therefore presents a technique that can be safely utilized to address catheter breakage complicating thrombectomy in different vascular anatomic locations.

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Section: Introductionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Direct Aspiration Catheter Fracture and Retrieval during Neurothrombectomy

Moshayedi¹,

Jadhav²

2018

Intervent Neurol

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“…Furthermore, the application of undue forward force during proximal stent deployment around curves can cause bending at the proximal marker band resulting in detachment at the ball and socket joint. Interestingly, resheathing appeared to offer some protection from detachment while retrieving around bends and not in straight anatomy 7 8…”

Section: Discussionmentioning

confidence: 99%

“…Castano et al 8 reported on successful snare retrieval in most type ‘A’ detachments (proximal to radio-opaque marker). However, this technique failed in type ‘B’ detachment (distal to radio-opaque marker) 8. Failed retrieval is likely when the proximal marker is positioned at an unfavourable angle abutting the wall of the artery or is not visualized.…”

Section: Discussionmentioning

confidence: 99%

Republished: Solitaire stentectomy: ‘deploy and engage’ and ‘loop and snare’ techniques

Parthasarathy

Gupta

Goel

et al. 2016

J NeuroIntervent Surg

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Solitaire FR stent-based mechanical thrombectomy provides clinical benefit in selected patients with acute ischaemic stroke due to large vessel occlusion. A dreaded device complication that is associated with poor technical and clinical outcome is stent detachment. Retrieval of the detached stent can be technically challenging and has been attempted with variable success. The key benefit of this strategy is the lack of need to administer fibrinolytic/antiplatelet agents that can potentially be catastrophic in the setting of acute stroke. Therefore, retrieval may be preferred to other strategies (balloon angioplasty, lytic/glycoprotein 2b/3a inhibitors administration) to address detached stent. We report two patients in whom the detached stent was retrieved using alternative techniques—‘deploy and engage’ and ‘loop and snare’—as snare retrieval failed.

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Principles for Complication Avoidance and Management in Thrombectomy for Ischemic Stroke

Chartrain

Awad

Mocco

2017

Cerebrovascular and Endovascular Neurosurgery

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Unwanted detachment of the Solitaire device during mechanical thrombectomy in acute ischemic stroke

Abstract: Unwanted detachment of a Solitaire is an uncommon complication during mechanical thrombectomy in patients with acute ischemic stroke and is associated with the clot retrieval attempts, SICH, poor outcome, and higher mortality.

Cited by 18 publications

References 14 publications

Direct Aspiration Catheter Fracture and Retrieval during Neurothrombectomy

Direct Aspiration Catheter Fracture and Retrieval during Neurothrombectomy

Republished: Solitaire stentectomy: ‘deploy and engage’ and ‘loop and snare’ techniques

Principles for Complication Avoidance and Management in Thrombectomy for Ischemic Stroke

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