A Novel Endovascular Therapy Strategy for Acute Ischemic Stroke Due to Intracranial Atherosclerosis-Related Large Vessel Occlusion: Stent-Pass-Aspiration-resCuE-Micowire-Angioplasty (SPACEMAN) Technique.

Yingchun Wu,Rui Sun,Junmei Wang,Yanan Zheng,Yuejiang Gui,Wenzhao Li,Guanqing Feng

doi:10.3389/fneur.2022.798542

Abstract

BackgroundThere is no clear consensus on the optimal endovascular treatment strategy for patients with ischemic stroke caused by ICAS-related large vessel occlusion (LVO). SPACEMAN, a novel thrombectomy technique that entails passing an aspiration catheter over the stent retriever and then retaining the microwire for angioplasty, has not been described. The aim of this prospective study was to evaluate our initial application of SPACEMAN and compare this technique with the Solumbra technique.MethodsForty-four consecutive patients with acute ischemic stroke resulting from ICAS-related LVO were randomly divided into two groups: Solumbra group (n = 22) and SPACEMAN group (n = 22). Demographic and clinical data were prospectively collected. Modified Rankin Scale (mRS) score of ≤ 2 of anterior circulation and mRS score ≤ 3 of posterior circulation at 3 months post-discharge was regarded as good prognosis.ResultsThe SPACEMAN group showed reduced mean time from femoral access to recanalization compared with the Solumbra group (39.55 ± 10.63 min vs. 50.73 ± 9.89 min, P = 0.001). The overall recanalization rate in the entire cohort was 93.18% (41/44). At 3-month follow-up, the overall good prognosis rate was 47.73%; 13 patients (59.09%) in the SPACEMAN group and 8 (36.36%) in the Solumbra group showed good prognosis. One patient in the SPACEMAN group (4.55%) and two patients in the Solumbra group (9.09%) developed symptomatic intracranial hemorrhage. The overall mortality rate was 4.55% (2/44).ConclusionsThis study suggests that SPACEMAN exhibits a shorter operation revascularization time than the standard thrombectomy. Complications and prognosis were comparable between the two groups. The safety and efficacy of this novel technique need to be studied in larger patient series.

Highlights

There is no clear consensus on the optimal endovascular treatment strategy for patients with ischemic stroke caused by Intracranial atherosclerosis (ICAS)-related large vessel occlusion (LVO)
Patients were chosen according to the following inclusion criteria: [1] age ≥18 years; [2] occlusion of the intracranial part of the internal carotid artery, or the first segment of the middle cerebral artery (M1), or intracranial vertebral (V4) and/or basilar artery (BA) occlusion demonstrated by magnetic resonance angiography (MRA), computed tomography (CT) angiography (CTA), or digital-subtraction angiography (DSA); [3] period between symptom onset and groin puncture
Symptomatic intracranial hemorrhage was determined as intracranial hemorrhage, including parenchymal hematoma, subarachnoid hemorrhage or intraventricular hemorrhage, associated with a NIHSS score ≥4 according to the guidelines of the European Cooperative Acute Stroke Study II (ECASSII) [17]

Summary

Introduction

There is no clear consensus on the optimal endovascular treatment strategy for patients with ischemic stroke caused by ICAS-related large vessel occlusion (LVO). Development of novel and more efficient endovascular strategies for patients with acute stroke caused by ICAS-related LVO is a key imperative. Rescue therapies such as intraarterial infusion of glycoprotein IIb/IIIa inhibitors, balloon angioplasty, and intracranial stenting are sometimes needed to achieve reperfusion in patients with stroke caused by ICAS-related LVO [5–12]. We present a novel strategy developed at our center for patients with ICAS which we refer to as the “SPACEMAN” technique (stent + pass + aspiration + rescue + micowire + angioplasty)

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Discussion

Conclusion