Abstract
Acute ischemic stroke resulting from intracranial vessel occlusion is associated with high morbidity and mortality. The mainstays of therapy are fibrinolytics and mechanical thrombectomy in properly selected patients. A new Food and Drug Administration-approved technology to perform thrombectomy, retrievable stenting, may provide superior revascularization rates and improved patient outcomes. We analyzed the cumulative human experience reported for the Trevo Pro Retrieval System (Stryker, Kalamazoo, MI, USA) and the Solitaire FR Revascularization Device (ev3, Irvine, CA, USA) as the definitive treatment for acute ischemic stroke. A literature search was undertaken to identify studies using the retrievable stents published up to September 2012. Nineteen studies identified a total of 576 patients treated with either the Trevo (n=221) or Solitaire (n=355) devices. Pooled data analysis identified median baseline National Institutes of Health Stroke Scale scores of 18.5±0.289 (standard error of the mean) and 17.9±0.610, and time to recanalization of 53.9±23.6minutes and 59.0±8.0minutes for the Trevo and Solitaire groups, respectively. Recanalization was variably defined by individual studies, most commonly achieving at least a thrombolysis in cerebral infarction score of 2a–3 or a thrombolysis in myocardial infarction score of 2–3. Revascularization (83%, 82%), mortality (31%, 14%), hemorrhage (8%, 6%), device complications (5%, 6%), and good patient outcomes (51%, 47%) were found with the Trevo and Solitaire devices, respectively. Preliminary analysis reveals excellent clinical outcomes for retrievable stent technology. This may be attributable to both high rates of revascularization with a relatively short time to perfusion restoration.
Highlights
Acute cerebral ischemia is a major cause of morbidity and mortality worldwide. 1-3 The mainstay of medical therapy is intravenous administration of recombinant tissue plasminogen activator to establish revascularization.[4]
While revascularization rates of 48% can be achieved with the Merci Retriever, a modified Rankin scale score of ≤ 2 is observed for only 27.7% of patients at 90 days.[11]
26 manuscripts were identified that reported the use of the Trevo or Solitaire devices
Summary
Acute cerebral ischemia is a major cause of morbidity and mortality worldwide. 1-3 The mainstay of medical therapy is intravenous administration of recombinant tissue plasminogen activator (rt-PA) to establish revascularization (reperfusion).[4]. Drug Administration (FDA) for mechanical thrombectomy in stroke patients.[9] The retriever has a corkscrew-shaped coil capable of extracting clots from occluded vessels and into the microcatheter. Another mechanical device, the Penumbra System (Penumbra, CA, USA) is an alternative approach to mechanical thrombectomy. During treatment with the Penumbra, a separator (microwire controlled by the operator) is used to dislodge the clot, while aspiration is applied through a proximal microcatheter.[10] Though revascularization rates with these devices are excellent 7,10-12, clinical outcomes have been discordant.[13,14] While revascularization rates of 48% can be achieved with the Merci Retriever, a modified Rankin scale (mRS) score of ≤ 2 is observed for only 27.7% of patients at 90 days.[11] the Penumbra yields a revascularization rate of 82%, but only 25% of patients have a mRS ≤ 2 at 90 days.[15]
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