Stent Retriever Mechanical Thrombectomy Research Articles

An Institutional Perspective on the Number of Stent Retriever Pass and Rate of Recanalization in Mechanical Thrombectomy for Acute Ischemic Stroke: When to Stop?

Mechanical thrombectomy is the standard treatment modality for flow restoration in acute ischemic stroke. In cases of persistent occlusion, the optimal number of retrieval attempts before considering procedure termination is currently undetermined and is a topic for research. Therefore in this study, we studied the impact of the number of stent retrieval maneuvers on the recanalization of vessels. In this retrospective single-center observational study we included 52 patients with large vessel occlusion who underwent stent retriever mechanical thrombectomy. Successful recanalization rate was defined as modified TICI (Thrombolysis in Cerebral Infarction) 2b or 3. The overall successful recanalization rate was 44.24%. The recanalization rate per stent retrieval attempt was the highest in 1st attempt (28.84%) and no recanalization was observed with the 3rd, 5th, and 6th attempts (p<0.001). At most 6 retrieval attempts were used. After two retrieval attempts, 91% of the patients were successfully recanalized and other after the 5th attempt could not result in recanalization.

The effect of stent retriever mechanical thrombectomy combined with tirofiban in treating acute ischemic stroke

Objective To analyze the effectiveness of stent retriever mechanical thrombectomy combined with tirofiban in treating acute ischemic stroke. Methods Markedly effective is defined as an SIS score of over 90, effective is indicated by an SIS score of between 50–90, and a score of below 50 suggests ineffective treatment results. Results ①The treatment’s overall effectiveness in the observation group (91.30%) was significantly higher than that in the control group (75.56%) (p < 0.05). ②The vascular recanalization rate in the observation group (89.13%) was significantly higher than that in the control group (71.11%) (p < 0.05). ③The stent retrieval operation count (2.41 ± 0.23) was significantly lower in the observation group than in the control group (1.29 ± 0.16) (p < 0.05). ④ After treatment, the platelet aggregation rate (10.74 ± 3.95) and NIHSS scores (6.58 ± 1.04) were significantly lower, and the Barthel index (77.86 ± 7.21) was significantly higher in the observation group compared to the control group (26.47 ± 5.12, 7.75 ± 2.36, 68.12 ± 6.15) (p < 0.05). All platelet aggregation rate, NIHSS scores and Barthel Index showed significant improvement after treatment when compared to those before treatment (p < 0.05). Conclusion The combined application of stent retriever mechanical thrombectomy and tirofiban in acute ischemic stroke treatment shows promising effectiveness. Compared to stent retriever alone, tirofiban adjunctive therapy enhances vascular recanalization, reduces retrieval procedures, shortens treatment duration, inhibits platelet aggregation, and improves neurological function recovery, daily living activities, and prognosis. Moreover, it doesn’t significantly increase symptom-related risks.

Abstract Number ‐ 149: Mechanical stent retriever thrombectomy of distal medium vessel occlusiono in acute ischemic stroke.

Introduction Randomized clinical trial (RTC) have demonstrated benefit of stent retriever mechanical thrombectomy (SRMT) of large vessel occlusion (LVO) in acute ischemic stroke (AIS) including with those present in 24 hours. However, trials have included predominately proximal middle cerebral artery (MCA, M1) and current recommendation is to perform SRMT in M1/M2. Therefore, AIS patients with distal medium vessel occlusion (DMVO)) with high NIHSS has no recommendation or options leading to disabilities. Objective of our study is to present the safety and feasibility of SRMT of DMVO who underwent SRMT. Additionally, we will describe technical aspect including their clinical and radiographic outcomes. Methods From a stroke‐endovascular databased, consecutive patient with SVO underwent SRMT from 2015–2022 were selected. Patient demographics including recanalization data with clinical and radiographic outcomes were collected. Results 7 patients (4 female) with median age of 65.66 (range 41–86), median NIHSS of 13 (range 7–19) and median ASPECT 8 (7‐10) presented with SVO; right M3 in 2 and left M3/M4 in 5 patients. Of 7 DMVO patients, one presented in 4 hours and receives intravenous rTPA, 2 presented in 12 hours and 4 presented in unknown time of onset but last known normal was 24 hours. One of the left M3/4 patients was a singer who (41 years old) absolutely do not wanted to be alive if she didn’t regain her speech. Similarly, another 42‐year‐old woman with left M3/4 clot was teacher wanted her speech restored for teaching. Endovascular strategies: all but one received rectal 300 mg aspirin and 500 ml normal saline bolus. Under conscious sedation, 8 French balloon catheters were used in all cases and the guide was flushed with heparin and nitroglycerine mixed saline. Solitaire SRMT in 5 cases (4×20 in 1 and 4×40 in 6 cases) and trevo in one (3×20 mm). Patient with solitaire SRMT required single pass in which trap technique (suction through CAT6 and retriever of SRD as a unit without shaving of clots) was utilized using CAT6 132 mm catheter 6 cases and Trevo SRMT required 3 passes. All achieved TICI 3 recanalization without complications. Outcomes: immediate post STMT, median NIHSS 2 (0‐6), 24 hours median NIHSS 1 (1‐6) and 90 days NIHSS 0 for all. 90 days mRS0 in 4, mRS1 in 1 and mRS2 in 1. 24 hours CT scan demonstrated small stroke in 2 patients. One patient lost follow up. 41‐year‐old singer immediately regained her speech after SRMT discharged home in 36 hours. 42‐year‐old teacher improved her speech and continue to teach. Conclusions Our case series demonstrated that SRMT in DMVO with disabling NIHSS is feasible and safe if performed carefully. All patient achieved TICI 3 perfusion and first pass effect was better in trap technique using long solitaire STD. Good function outcomes were achieved in all cases irrespective of the types of SRD used and passes required to achieve TICI 3 perfusion. Further studies are required.

Parallel stent retriever mechanical thrombectomy of an acute internal carotid artery occlusion refractory to standard techniques: A case report

Although mechanical thrombectomy for acute large vessel occlusion is generally effective, some occlusions are refractory. We report a patient in whom the parallel stent retriever technique using two Trevo stent retrievers (Stryker Neurovascular, Fremont, California, USA) was required to treat an intracranial and epidural internal carotid artery occlusion after other techniques had failed. A 68-year-old woman presented with an acute left internal carotid artery occlusion 4 days after mechanical thrombectomy of a left middle cerebral artery occlusion. She was not a candidate for intravenous thrombolysis because of a recent cerebral infarction. Attempts at mechanical thrombectomy using a stent retriever, contact aspiration, or combined contact aspiration and stent retriever were unsuccessful. The parallel stent retriever technique using two 6 × 25-mm Trevo stent retrievers enabled coverage of the entire thrombus, and successful reperfusion was achieved (extended Thrombolysis in Cerebral Infarction grade 2b). After the procedure, the patient was able to walk without assistance. Her modified Rankin Scale score was 2 at 90 days follow-up. Microscopic examination of the retrieved thrombi demonstrated red blood cells, fibrin, and partial endothelialization. The parallel Trevo stent retriever technique has the potential as rescue therapy for refractory large-vessel occlusion. However, complications arising from this technique remain uncertain. Further studies are needed to determine the effect of this technique in terms of recanalization and clinical safety.

Effect on Successful Recanalization of Thrombus Length in Susceptibility- weighted Imaging in Mechanical Thrombectomy with Stentretrieval.

Susceptibility-Eeighted Imaging (SWI) enables visualization of thrombotic material in acute ischemic stroke. We analyzed the association between thrombus length on SWI and the success rate of recanalization in stent-retriever mechanical thrombectomy. A retrospective study was performed on 128 patients with Middle Cerebral Artery (MCA) thrombus on pretreatment SWI. The patients were divided into 2 groups, the successful recanalization and the failed recanalization group. Thrombus visibility and location on SWI were compared to those on Maximum Intensity Projection (MIP) in Computed Tomography (CT) angiography. A comparative analysis was performed in terms of clinical and radiologic outcomes as well as complications with respect to multiple categories. No significant differences were noted in terms of baseline characteristics and clinical outcomes between the 2 groups. However, compared with the successful recanalization group, the failed recanalization group had a larger number of stent-retriever passages and a longer thrombus length (p = 0.027 and 0.014, respectively). Multivariate analyses revealed that a larger mean number of stent-retriever passages was a predictive factor for failure of recanalization (odds ratio [OR] 1.60; 95% confidence Interval [CI] 1.12-2.08; p = 0.04). Thrombus length (OR 9.91; 95% CI 3.89-13.87; p < 0.001) and atrial fibrillation (OR 5.38; 95% CI 1.51-9.58; p = 0.008) were separately associated with more than 3 stent-retriever passages. Thrombus length has been identified as a predictor of recanalization failure in mechanical thrombectomy. A significant decline in the success rate of recanalization was associated with longer thrombus length.

Mechanical thrombectomy in acute ischemic stroke: a single-center experience

Aim. Mechanical thrombectomy is standard of care for the treatment of acute ischemic stroke. The objective of this study is to analyze the results of our own experience of endovascular treatment in Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” Kemerovo.Methods. 12 patients with AIS and underwent mechanical thrombectomy with «Trevo» stent-retriever were included in this analysis. Primary outcomes included 90-day modified Rankin scale (mRS) score, first pass effect (FPE) and recanalization rate (TICI score), the combined incidence of postintervention hemorrhages and mortality at 90 days.Results. Among 12 patients (66.7% male, age 59.5 [57.5; 66.5] years) hypertension were in 100%, 61.5% had an ischemic heart disease, 53.8% was current smoking and atrial fibrillation. Median of the NIHSS scale was 13 points, mRS≥4 was in 75% of patients. In 33.3% was a tandem lesion (internal carotid artery terminus and middle cerebral artery) and 25% required stenting of the carotid artery. Good clinical outcomes (mRS≤2 at 90 days) were achieved in 77.8% (7/9) among surviving patients. The 90-day NIHSS score – 4 [1; 5]. The first pass effect and recanalization rate (TICI Scores 2b-3/3) was achieved in 50% and 91.7% of patients. The combined incidence of postintervention hemorrhages and mortality at 90 days was 33.3% and 25% respectively.Conclusion. Despite the small sample size, stent retriever mechanical thrombectomy in AIS provides satisfactory clinical results.

Safety and Efficacy of Intra-arterial Tirofiban Injection During Mechanical Thrombectomy for Large Artery Occlusion.

The safety and effect of intra-arterial (IA) tirofiban, a glycoprotein IIb/IIIa inhibitor, during the stent retriever mechanical thrombectomy (MT) was investigated. From January 2015 to May 2019, a total of 327 patients underwent mechanical thrombectomy of large artery occlusions (LAO). Patients were classified into two groups: MT with IA tirofiban (MTT) group and MT only (MTO, without IA tirofiban) group. Clinical outcomes, radiological results, and various complications, such as post thrombectomy hemorrhage, symptomatic hemorrhage, other systemic bleeding, and hemorrhagic transformation of infarct were evaluated by comparing the MTT group and MTO group. In addition, subgroup analysis was performed for patients who underwent MT with prior intravenous (IV) tissue plasminogen activator (t-PA). The MTT group needed a lower mean number of stent passes and showed a re-occlusion rate as compared with the MTO group (P=0.038 and 0.022, respectively). Between the two groups, there were no statistically significant differences in post thrombectomy hemorrhage, symptomatic hemorrhage, other systemic bleeding complications, or hemorrhagic transformation of infarct (P = 0.511, 0.397, 0.429, and 0.355, respectively). In the subgroup analysis, similar findings were observed. The use of IA tirofiban during MT seems to be safe and potentially more effective than only MT without IA tirofiban, even in patients who used IV t-PA before MT.

Efficiency of mechanical thrombectomy in acute ischemic stroke patients

The aim of this single-center study is to assess the outcomes in patients with acute ischemic stroke underwent endovascular mechanical thrombectomy. The data and outcome of patients who were admitted due to acute ischemic stroke caused by a large vessel occlusion in the anterior or posterior circulation and treated with endovascular stent retriever mechanical thrombectomy between 2014 and 2018 were retrospectively evaluated. Recanalization success was assessed based on Thrombolysis in Cerebral Infarction (TICI) scores, and the TICI grades 2b and 3 were considered as ‘successful’. Functional outcomes of the patients were assessed by modified Rankin Scale (mRS) at the 3rd month follow up and a score of ≤2 points was considered as ‘good clinical outcome’. Successful recanalization was achieved in 34 patients (69%). At the 3rd month follow-up, 23 patients (46,9%) had mRS scores of ≤2 points. The overall mortality rate at the 90th day was %30 (n=15). After endovascular thrombectomy, symptomatic intracranial hemorrhage was seen in 9 patients, groin hematoma due to vascular access in 5 patients, which did not require additional treatment, and pseudoaneurysm in 3 patients. Stent retriever mechanical thrombectomy is an effective and safe procedure in patients admitted due to acute ischemic stroke caused by large vessel occlusion.

‘Real-world’ comparison of first-line direct aspiration and stent retriever mechanical thrombectomy for the treatment of acute ischemic stroke in the anterior circulation: a multicenter international retrospective study

BackgroundThrombectomy for anterior large vessel occlusion less than 24 hours since last known well is now standard of care. Certain aspects of clinical trials may limit generalizability to ’real-world' practice.ObjectiveTo...

PMD56 - COST OF STENT-RETRIEVER MECHANICAL THROMBECTOMY IN PATIENTS WITH ISCHEMIC STROKE IN THE RUSSIAN FEDERATION

To evaluate the cost of stent-retriever mechanical thrombectomy (MTE) in patients with acute ischemic stroke (AIS) from the Russian government perspective. The model was developed to simulate health outcomes and associated costs of three treatment scenarios: 1) MTE added to thrombolytic therapy (MTE + TLT); 2) MTE alone; 3) no reperfusion. Direct medical, direct non-medical and indirect costs due to AIS and its consequences were calculated for 5 years horizon. Number of patients eligible for reperfusion was estimated on the base of available data on epidemiology of AIS in RF. Patients were considered eligible for all 3 scenarios if they were taken to hospital within 4.5 hours after stroke onset, or for scenarios 2 and 3 if they were hospitalized within 6 hours. Outcome data on functional independence, disability or death were taken from meta-analysis of Campbell BC et al., 2016. The sensitivity analyses was carried out. When MTE+TLT is performed within 4.5 hours after stroke onset, AIS burden comprises 16.7 mln EURO. In the absence of reperfusion or MTE only the burden is 21.4 and 18.9 mln EURO, respectively. If MTE takes place within 6 hours after stroke onset, the economic burden of AIS is 24.2 mln EURO, that is 1.8 mln EURO less than when reperfusion is not performed. MTE + TLT or MTE alone lead to a reduction in the overall economic burden of AIS since the 2nd year after acute disease. Decrease of direct non-medical and indirect costs due to disability and death compensates increase in direct medical costs. The investments into MTE were fully covered on the 5th year. The use of MTE + TLT or MTE alone in patients with AIS is an efficient option of AIS treatment in Russia due to the decrease of direct non-medical and indirect costs.

Primary Results of the Multicenter ARISE II Study (Analysis of Revascularization in Ischemic Stroke With EmboTrap).

EmboTrap is a novel stent retriever designed to achieve rapid and substantial flow restoration in acute ischemic stroke secondary to large-vessel occlusions. Here, we evaluated EmboTrap's safety and efficacy compared with established stent retrievers. ARISE II (Analysis of Revascularization in Ischemic Stroke With EmboTrap) was a single-arm, prospective, multicenter study, comparing the EmboTrap device to a composite performance goal criterion derived using a Bayesian meta-analysis from the pivotal SWIFT (Solitaire device) and TREVO 2 (Trevo device) trials. Patients at 11 US and 8 European sites were eligible for inclusion if they had large-vessel occlusions and moderate-to-severe neurological deficits within 8 hours of symptom onset. The primary efficacy end point was achievement of modified Thrombolysis in Cerebral Ischemia (mTICI) reperfusion scores of ≥2b within 3 EmboTrap passes as adjudicated by the core laboratory. The primary safety end point was a composite of symptomatic intracerebral hemorrhage and serious adverse device effects. Secondary end points included functional independence (modified Rankin Scale, 0-2) and all-cause mortality at 90 days. Between October 2015 and February 2017, 227 patients were enrolled and treated with the EmboTrap device. The primary efficacy end point (mTICI ≥2b within 3 passes) was achieved in 80.2% (95% confidence interval, 74%-85% versus 56% performance goal criterion; P value, <0.0001), and mTICI 2c/3 was 65%. After all interventions, mTICI 2c/3 was achieved in 76%, and mTICI ≥2b was 92.5%. The rate of first pass (mTICI ≥2b following a single pass) was 51.5%. The primary safety end point composite rate of symptomatic intracerebral hemorrhage or serious adverse device effects was 5.3%. Functional independence and all-cause mortality at 90 days were 67% and 9%, respectively. The EmboTrap stent-retriever mechanical thrombectomy device demonstrated high rates of substantial reperfusion and functional independence in patients with acute ischemic stroke secondary to large-vessel occlusions. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02488915.

ACUTE RECANALIZATION OF THROMBO-EMBOLIC ISCHEMIC STROKE WITH APERIO DEVICE

Introduction: There are a large number of studies in the literature reporting the clinical results of second generation stent retriever mechanical thrombectomy (MT) devices for acute ischemic stroke (AIS). A limited number of studies have been conducted with Aperio, another MT device that went into clinical use in recent years. This study aims to evaluate the efficacy of Aperio in patients diagnosed with AIS and the factors affecting the success of recanalization. Material method: A total of 26 patients (18 females and 8 males) diagnosed with acute ischemic stroke (AIS) with a mean age of 63.92±13.88, who underwent MT with the Aperio (Acandis®,GmbH–Pforzheim, Germany) device in Neurology Clinic of Gaziantep University Medical Faculty between 2015-2017. The diseases of the patients, the onset of neurological symptoms, times to arrive the hospital, National Institute of Health Stroke Scale (NIHHS) scores and catheterization times were recorded from the files of the patients retrospectively. From the scanned files, AIS patients who were intervened only with Aperio mechanical thrombectomy device were included in the study. The recanalization success after MT was defined as mTICI (modified Thrombolysis In Cerebral Infarction) 2b and 3 (ensuring recanalization more than 50%). Results: MCA M1 (57.7%) was the most common lesion in the angiographic imaging of the patients, and ICA was present in 23.1% of the patients. The blood flow was restored (mTICI 2b and 3) in 77% of the patients. The MT success was found to be correlated with the time from the onset of symptoms of the patients until the time when they were taken to the angiography laboratory (p=0.003). When the cut-off value from the onset of symptoms to the time when the patients were taken to angiography was taken as 5.5 hours, the sensitivity was found to be 90% and specificity to be 83.3% for a successful thrombectomy (AUC SE.: 0.879 (0.083), p

Effectiveness and Safety of Mechanical Thrombectomy with Stent Retrievers in Basilar Artery Occlusion: Comparison with Anterior Circulation Occlusions.

ObjectiveAcute basilar artery occlusion (BAO) is associated with severe neurological dysfunction and high mortality rates. The benefits of mechanical thrombectomy in BAO have not been explored in recent clinical trials. Therefore, we analyzed outcomes of stent retriever mechanical thrombectomy for BAO, and compared with anterior circulation occlusions (ACO).MethodsIn total, 161 consecutive patients (24 BAO, 137 ACO) who underwent mechanical thrombectomy with the stent retriever between January 2013 and August 2016 enrolled in our study. All patients underwent clinical assessment with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS). Radiological results were used to evaluate thrombolysis in cerebral infarction (TICI) scores and successful recanalization was defined by TICI 2b or 3.ResultsMean NIHSS scores at 24 hours and 30 days were significantly higher in the BAO group than the ACO group (p=0.021, p=0.001). mRS at 90 days was significantly higher in the BAO group (4.2) compared with the ACO group (3.0) (p=0.003). The BAO group (2.0) performed fewer stent retriever passages than the ACO group (2.7) (p=0.049). There were no significant differences between the two groups in terms of complications, but the BAO patients experienced a higher mortality (16.6%) rate than ACO patients (5.8%) (p=0.001). In subgroup analysis of BAO, patients with short procedure times achieved successful recanalization (p=0.001) and successfully recanalized patients exhibited more favorable mRS at 90 days (p=0.027).ConclusionIn our study, mechanical thrombectomy of BAO patients showed worse clinical outcome and higher mortality rate than ACO patients. However, mechanical thrombectomy with a stent retriever in BAO is an effective treatment, because successfully recanalized patients showed good clinical outcome in BAO patients.

TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry

BackgroundRecent randomized clinical trials (RCTs) demonstrated the efficacy of mechanical thrombectomy using stent-retrievers in patients with acute ischemic stroke (AIS) with large vessel occlusions; however, it remains unclear if these...

Intra-Arterial Alteplase Thrombolysis during Mechanical Thrombectomy for Acute Ischemic Stroke

Intra-arterial alteplase (IA tPA) is commonly used during mechanical thrombectomy for acute ischemic stroke in patients with large-vessel occlusion, but specific indications and applications for its use remain undefined. We analyzed 40 patients who underwent stent-retriever mechanical thrombectomy, 28 of whom received adjunctive IA tPA. To our knowledge, this is the largest cohort with this concomitant treatment reported in the literature in the post-mechanical thrombectomy trial era. Between patients with and without IA tPA, rates of hemorrhagic conversion, neurologic outcome, and mortality were equivalent, with a trend toward improved angiographic revascularization observed in the IA tPA group. IA tPA is a safe adjunct to mechanical thrombectomy, and more investigation is warranted to understand ideal indications and dosage methodologies.

Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain.

To assess the cost-effectiveness of stent-retriever mechanical thrombectomy and intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in patients with acute ischaemic stroke due to large vessel occlusions in Spain. Clinical data were taken from the SWIFT PRIME clinical trial. A lifetime Markov state transition model defined by the modified Rankin Scale score was developed to estimate costs and health outcomes (life years gained and quality adjusted life years). A Spanish National Health System perspective (direct medical costs) was considered. Resource utilisation and utilities were obtained from available published data and endorsed by an expert panel. Costs (€, 2016) were obtained from various Spanish sources. Deterministic and probabilistic sensitivity analyses were performed. Stent-retriever thrombectomy after intravenous tissue plasminogen activator was associated with better outcomes (1.17 life years gained and 2.51 quality adjusted life years) and savings of €44,378, resulting in a dominant therapy over intravenous tissue plasminogen activator alone. A net monetary benefit of €119,744 was obtained considering a willingness-to-pay threshold of €30,000/quality adjusted life year gained. The combined therapy was also dominant in all sensitivity analyses, deterministic and probabilistic. The results were consistent with a previously published cost-effectiveness analysis and reinforce the likeliness of the selection of stent-retriever mechanical thrombectomy plus intravenous tissue plasminogen activator over intravenous tissue plasminogen activator alone. Stent-retriever thrombectomy after intravenous tissue plasminogen activator is a dominant alternative over intravenous tissue plasminogen activator alone (more effective and less costly) for the treatment of acute ischaemic stroke patients with large vessel occlusions in the Spanish setting.

Comparison of non-stent retriever and stent retriever mechanical thrombectomy devices for the endovascular treatment of acute ischemic stroke.

OBJECTIVE Mechanical thrombectomy is standard of care for the treatment of acute ischemic stroke. However, limited data are available from assessment of outcomes of FDA-approved devices. The objective of this study is to compare clinical outcomes, efficacy, and safety of non-stent retriever and stent retriever thrombectomy devices. METHODS Between January 2008 and June 2014, 166 patients treated at Jefferson Hospital for Neuroscience for acute ischemic stroke with mechanical thrombectomy using Merci, Penumbra, Solitaire, or Trevo devices were retrospectively reviewed. Primary outcomes included 90-day modified Rankin Scale (mRS) score, recanalization rate (thrombolysis in cerebral infarction [TICI score]), and incidence of symptomatic intracranial hemorrhages (ICHs). Univariate analysis and multivariate logistic regression determined predictors of mRS Score 3-6, mortality, and TICI Score 3. RESULTS A total of 99 patients were treated with non-stent retriever devices (Merci and Penumbra) and 67 with stent retrievers (Solitaire and Trevo). Stent retrievers yielded lower 90-day NIH Stroke Scale scores and higher rates of 90-day mRS scores ≤ 2 (22.54% [non-stent retriever] vs 61.67% [stent retriever]; p < 0.001), TICI Score 2b-3 recanalization rates (79.80% [non-stent retriever] vs 97.01% [stent retriever]; p < 0.001), percentage of parenchyma salvaged, and discharge rates to home/rehabilitation. The overall incidence of ICH was also significantly lower (40.40% [non-stent retriever] vs 13.43% [stent retriever]; p = 0.002), with a trend toward lower 90-day mortality. Use of non-stent retriever devices was an independent predictor of mRS Scores 3-6 (p = 0.002), while use of stent retrievers was an independent predictor of TICI Score 3 (p < 0.001). CONCLUSIONS Stent retriever mechanical thrombectomy devices achieve higher recanalization rates than non-stent retriever devices in acute ischemic stroke with improved clinical and radiographic outcomes and safety.

Intravenous Thrombolysis Facilitates Successful Recanalization with Stent-Retriever Mechanical Thrombectomy in Middle Cerebral Artery Occlusions

Several factors influence the outcome after acute ischemic stroke secondary to proximal occlusions of cerebral vessels. Among others, noneligibility for intravenous thrombolysis (IVT) and incomplete revascularization have been identified as predictors of unfavorable outcome. The aim of this study was to investigate whether concomitant IVT influences the revascularization efficacy in mechanical thrombectomy (MT). This study conducted a retrospective analysis of all consecutive patients presenting with an anterior circulation stroke due to large-artery occlusion with imaging evidence who were treated with MT between July 2012 and December 2013 at 2 high-volume stroke centers. Imaging data were regraded and re-evaluated according to the modified Treatment in Cerebral Ischemia scale and its respective vessel occlusion site definitions. Clinical end points included National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale; imaging and procedural measures were technical end points. We identified 93 patients who presented with an occlusion of the middle cerebral artery (MCA): of these patients, 66 (71%) received IVT. We did not find statistically significant differences in the baseline NIHSS score, time from symptom onset to groin puncture, and age when comparing the IVT group with the non-IVT group. The rate of successful recanalizations (modified Treatment in Cerebral Ischemia score ≥ 2b) was significantly higher in patients with MCA occlusion and concomitant IVT (P = .01). Stepwise logistic regression identified IVT and thrombus length as predictive factors for successful mechanical recanalization (P = .004, P = .002). IVT and thrombus length are predictive factors for a successful recanalization in MT for acute ischemic stroke with underlying MCA occlusion.

Risk of distal embolization with stent retriever thrombectomy and ADAPT

BackgroundThere is a discrepancy in clinical outcomes and the achieved recanalization rates with stent retrievers in the endovascular treatment of ischemic stroke. It is our hypothesis that procedural release of...

Double solitaire mechanical thrombectomy in acute stroke: effective rescue strategy for refractory artery occlusions?

Mechanical thrombectomy by using a single stent retriever system has demonstrated high efficacy for recanalization of large-artery occlusions in acute stroke. We aimed to evaluate the feasibility, safety, and efficacy of a novel double Solitaire stent retriever technique as an escalating treatment for occlusions that are refractory to first-line single stent retriever mechanical thrombectomy. All patients treated with the double stent retriever technique by using the Solitaire system were retrospectively selected from 2 large neurointerventional centers. Time to recanalization, angiographic (TICI) and clinical outcomes (mRS), and complications were assessed. Ten patients (median NIHSS score, 16; mean age, 70 years) with MCA M1 segment (n = 5) and terminal ICA (n = 5 including 2 ICA tandem) occlusions were included. Prior single stent retriever mechanical thrombectomy had been performed in 9 patients (median number of passes, 3). Median time to recanalization was 60 minutes (interquartile range, 45-87 minutes). Procedure-related complications occurred in 1 patient; overall mortality was 20%. Recanalization of the target vessel (TICI 2b/3) was achieved in 80%. Good clinical outcome (mRS 0-2) was 50%. In this preliminary feasibility study, the double Solitaire stent retriever technique proved to be an effective method for recanalization of anterior circulation large-artery occlusions refractory to standard stent retriever mechanical thrombectomy.