Abstract
PurposeMechanical thrombectomy using the Solitaire device has become a standard treatment of ischemic stroke due to large vessel occlusions. Inadvertent detachment is a feared complication, which is associated with poor clinical outcome. The aim of this experimental study was to assess in a porcine model the feasibility and effectiveness of rescuing detached Solitaire devices using different stent retrievers.MethodsSolitaire FR devices (4 × 15/20 mm and 6 × 20/30 mm) were placed in the axillary artery of pigs. By means of 3 different stent retrievers (Trevo ProVue; EmboTrap II revascularization device; 3D revascularization device) a total of 24 rescue maneuvers (8 per retriever) were performed by deploying the retrievers within the deployed Solitaire devices and trapping parts of the Solitaire within the microcatheter. Rescue rates, rescue time and complications were assessed.ResultsOverall stentectomy of the Solitaire devices was successful in all cases (100%). Time of rescue was comparable using the applied stent retrievers (Trevo ProVue; EmboTrap II revascularization device; 3D revascularization device). Complications, such as entrapment of the Solitaire-retriever complex at the intermediate catheter, Solitaire migration, vasospasm, perforation, or dissection were not observed.ConclusionStentectomy of inadvertently detached Solitaire devices using different stent retrievers is a feasible and effective method. Rescue rates and times with the Trevo ProVue, EmboTrap II and 3D revascularization device were comparable.
Highlights
Since 2015, mechanical thrombectomy with retrievable stents has become a standard treatment of ischemic stroke due to large vessel occlusion with very good clinical outcome [1]
We implanted a total of 24 Solitaire FR devices of different sizes (4 × 15 mm n = 4, 4 × 20 mm n = 8, 6 × 20 mm n = 4 and 6 × 30 mm n = 8)
The results show that overall rescues of detached Solitaire devices of different sizes were successful in 100% (24 of 24 cases)
Summary
Since 2015, mechanical thrombectomy with retrievable stents has become a standard treatment of ischemic stroke due to large vessel occlusion with very good clinical outcome [1]. The Solitaire AB/FR device (Medtronic, Irvine, CA, USA) was the first fully retrievable and self-expanding intracranial stent available [2]. This device was designed for stent-assisted treatment of intracranial aneurysms [3]. In 2008, one of the first cases was described in the literature where a Solitaire was used to retrieve an intra-arterial thrombus [4]. The Solitaire device passed through several revisions (Solitaire 2 and Solitaire Platinum), leading to the current 2019 version Solitaire X and is probably the most widely used stent-retriever in the world.
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