E-044 Stent Retriever Thrombectomy and Local Aspiration with a Navigable and Flexible Second Generation Support Catheter for Acute Ischemic Stroke: The "Sol-Arc" Technique

Abstract

Multiple recent randomized controlled trials have proven the benefit of mechanical thrombectomy using stent retrievers for emergent large vessel occlusion (ELVO).1–5 Techniques currently used for endovascular treatment of stroke employ either direct aspiration, stent retriever thrombectomy or a combination of both. When stent retrievers are used, temporary flow arrest with an extracranial balloon guide catheter or assisted local aspiration with a large bore intracranial suction catheter is recommended. This allows for more complete recanalization and prevents embolization to previously uninvolved territories. Recent advancements in large bore intracranial suction catheter technology have made it easier to utilize coaxial stent retriever thrombectomy assisted by local aspiration. At our high-volume comprehensive stroke center, we have found the second generation large bore intracranial Arc support catheter (ev3 Neurovascular, Irvine, CA) to be extremely effective when used in combination with the Solitaire stent retriever (ev3 Neurovascular, Irvine, CA). We have found the Arc support catheter to be much more navigable, less prone to kinking and easier to deliver into the M1 segment (without causing spasm) than the first generation local aspiration catheters. Additionally, the Arc support catheter is less costly than the currently available suction catheters. The Sol-Arc technique begins with placement of a stent retriever device across the embolic occlusion by deployment though a 021 or 027 microcatheter. This microcatheter is placed coaxially through the Arc support catheter which is positioned just proximal to the embolus. After waiting 5 minutes, the stent retriever is pulled inside the Arc support catheter which is simultaneously aspirated. Subsequently, the Arc support catheter is removed while aspirating the guiding sheath in the neck. This technique should allow for faster, safer and more successful stent retriever thrombectomy when used in conjunction with local aspiration.DisclosuresA. Onofrio: None. A. Miller: None. J. Hise: None. I. Thacker: None. J. Haithcock: None. D. Graybeal: None. K. Layton: None.

A Direct Aspiration First Pass Technique for Mechanical Thrombectomy in the Setting of a Suspected Cerebral Aneurysm

“…Another recent study showed dramatically improved clinical outcomes and recanalization rates for the Sol-Arc technique, which used a Solitaire stent retriever in conjunction with the Arc catheter (Medtronic, Minneapolis, MN) for locally assisted aspiration stent retriever thrombectomy. The authors reported a 92% successful recanalization rate and no complications; 42% of these patients were discharged home with an NIHSS of 0 and 67% of the patients had a favorable modified Rankin Scale (mRS) of 0-2 at 90 days [ 7 ]. Our case was unique in that the patient had multiple known and suspected unknown aneurysms, prompting a less traumatic approach to remove the clot at the right MCA bifurcation.…”

Successful reperfusion of bilateral middle cerebral artery embolic occlusions using stent retriever thrombectomy

“…The Sol-Arc technique was employed in this case, because it has been shown to have a high success rate and safety rating. 8 Using this technique, a large-bore intracranial support catheter is placed just proximal to the embolic occlusion. Coaxially, a stent retriever device is placed across the embolic occlusion with a 0.021-inch or 0.027-inch microcatheter.…”