Abstract
Background: Solitaire, a representative stent retriever, has shown high performance in removing embolic clots. However, its reperfusion potential in intracranial atherosclerotic stenosis (ICAS)-related occlusions has rarely been reported. In this ROSE ASSIST study, we hypothesized that Solitaire device is as effective and safe for removing in situ thrombi in ICAS-related occlusions as it is for removal of embolic occlusions.Methods: Data from ASIAN KR, an observational multicenter registry (n = 720) enrolling patients who have undergone endovascular treatment for acute cervicocephalic artery occlusions, were retrospectively reviewed. Through blinded evaluations, occlusions were classified as ICAS-related (significant fixed focal stenosis observed at the occlusion site during endovascular treatment) or embolic (no or minimal stenosis observed). Among patients treated within 720 min after stroke onset, those who undertook Solitaire thrombectomy and whose underlying etiology was ICAS-related or embolic were included. The primary endpoint was immediate successful reperfusion (modified Treatment In Cerebral Ischemia 2b−3) after Solitaire stent retrieval. The safety endpoint included intracerebral hemorrhagic transformation and subarachnoid hemorrhage. Comparative analyses were performed between embolic and ICAS-related occlusions with 2:1 propensity score matching.Results: In total, 303 patients (embolic, 228; ICAS-related, 75) were included in the analyses. As for the primary endpoint, the immediate successful reperfusion rate following Solitaire thrombectomy did not differ between the two etiologic groups after propensity score matching (73.1% embolic vs. 65.8% ICAS-related, p = 0.261). The final successful reperfusion grade was also similar in the two groups (79.3 vs. 72.0%, p = 0.219). The grades and frequencies of intracerebral hemorrhagic transformation and subarachnoid hemorrhage did not differ between groups (p = 0.134 and p = 0.269, respectively).Conclusions: The immediate reperfusion performance in terms of thrombus removal of Solitaire thrombectomy for ICAS-related occlusions was similar to that for embolic occlusions.
Highlights
Mechanical thrombectomy with stent retrievers has achieved high level of evidence for the treatment for patients with acute ischemic stroke caused by intracranial large artery occlusion [1]
The ROSE ASSIST study was designed for proving effectiveness and safety of Solitaire thrombectomy for thrombus removal in intracranial atherosclerotic stenosis (ICAS)-related occlusions
Seventy-five and 228 patients were included in the ICAS and embolic groups, respectively, based on the study criteria (Figure 1)
Summary
Mechanical thrombectomy with stent retrievers has achieved high level of evidence for the treatment for patients with acute ischemic stroke caused by intracranial large artery occlusion [1]. Its effectiveness for large artery occlusions due to intracranial atherosclerotic stenosis (ICAS) and in situ thrombosis has rarely been reported. In Asia, acute ischemic strokes from intracranial large artery occlusions are often caused by in situ atherosclerotic mechanisms [11,12,13]. Its reperfusion potential in intracranial atherosclerotic stenosis (ICAS)-related occlusions has rarely been reported In this ROSE ASSIST study, we hypothesized that Solitaire device is as effective and safe for removing in situ thrombi in ICAS-related occlusions as it is for removal of embolic occlusions
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