Mechanical Thrombectomy with a Self-Expanding Retrievable Intracranial Stent (Solitaire AB): Experience in 26 Patients with Acute Cerebral Artery Occlusion: Fig 1.

F Miteff,B.S Steinfort,T.J Harrington,C Sue,K.C Faulder,A.C.C Goh

doi:10.3174/ajnr.a2447

Abstract

Patients with stroke unsuitable for IV thrombolysis may be considered for endovascular revascularization, particularly when baseline imaging suggests proximal cerebral vessel occlusion associated with minimal established infarction. This retrospective review describes the use of a self-expanding retrievable intracranial stent (Solitaire AB) for thrombectomy in acute ischemic stroke. Twenty-six consecutive patients with stroke treated endovascularly by using the Solitaire stent were identified, followed by detailed review of data extracted from their imaging and clinical records. Recanalization (TIMI grade ≥2) was achieved with Solitaire thrombectomy as the single treatment technique in 16 patients and in combination with urokinase or the Penumbra device in 9 of the remaining 10 patients. Two patients had symptomatic intracranial hemorrhage. A favorable clinical outcome (mRS score of ≤2) was seen in 3 of 5 patients with MCA occlusion, 6 of 11 (55%) patients with ICA occlusion, and 2 of 10 patients with BA occlusion. Mechanical thrombectomy by using the Solitaire stent appears to be safe and is capable of achieving a high rate of recanalization and favorable clinical outcomes in patients presenting with proximal cerebral vessel occlusion.

Highlights

MethodsTwenty-six consecutive patients with stroke treated endovascularly by using the Solitaire stent were identified, followed by detailed review of data extracted from their imaging and clinical records
AND PURPOSE: Patients with stroke unsuitable for IV thrombolysis may be considered for endovascular revascularization, when baseline imaging suggests proximal cerebral vessel occlusion associated with minimal established infarction
Mechanical thrombectomy by using the Solitaire stent appears to be safe and is capable of achieving a high rate of recanalization and favorable clinical outcomes in patients presenting with proximal cerebral vessel occlusion

Summary

Methods

Twenty-six consecutive patients with stroke treated endovascularly by using the Solitaire stent were identified, followed by detailed review of data extracted from their imaging and clinical records. Patient Selection Data were extracted from our interventional neuroradiology data base, which records the clinical and radiologic details of all patients with acute ischemic stroke treated by endovascular means Patients in this data base had the following characteristics: 1) They did not meet selection criteria for IV thrombolysis.1 2) Their clinical presentation demonstrated a significant neurologic deficit. INTERVENTIONAL ORIGINAL RESEARCH tion (dysphasia, visuospatial disorder) with a homonymous visual field defect and hemisensory motor deficit; or a PACS, combining at least 2 of the aforementioned deficits or alternatively including any POCS.2 3) Their noninvasive angiographic imaging confirmed persistent proximal cerebral vessel occlusion. This involved the ICA, MCA mainstem or bifurcation, or the BA. Ischemia within the posterior circulation was not quantified according to any formal scale and showed no or very little established infarction, usually assessed by MR imaging

Results

Discussion

Conclusion