Impact of Retrievable Stents on Acute Ischemic Stroke Treatment

Abstract

BACKGROUND AND PURPOSE:Retrievable stents combine the high recanalization rate of stents and the capability of removing the thrombus offered by mechanical thrombectomy devices. We hypothesized that retrievable stents shorten time to recanalization in the multimodal approach for endovascular stroke treatment.

Technical Feasibility and Application of Mechanical Thrombectomy with the Solitaire FR Revascularization Device in Acute Basilar Artery Occlusion

“…Only 3 patients with asymptomatic hemorrhages, according to the PRO-ACT II criteria, 22 were observed on routine posttreatment imaging. This low hemorrhage rate compares favorably with the rates of symptomatic intracranial hemorrhage reported in other stentretriever studies (0% to 17%) 10,11,15,16 and with acute BAO treatment (0% to 19%). 8,9,23,24,26,36,37 This study has inherent limitations due to the retrospective design and the small number of patients.…”

“…[10][11][12][15][16][17] acute BAOs in their series of 50 patients with large vessel occlusion stroke. Successful recanalization (defined as TICI 3) was achieved in 81% (13/16), with a mean of 2.1 passes.…”

“…Once fully deployed, a control angiogram was obtained to assess immediate recanalization effect. According to the results of previous animal and clinical studies, 10,18 the device was left in place for 5 minutes to allow the clot to become embedded in the stent before the microcatheter was then advanced to partially resheath the proximal connection site of the stent to the pusher wire. The Solitaire FR and the microcatheter were retrieved simultaneously during aspiration with a 60-mL syringe at the guide catheter.…”

“…Recent data of our own have demonstrated that adding retrievable stents to a multimodal approach in acute ischemic stroke treatment reduces the time to recanalization and further increases the recanalization rate to over 90%. 10 However, most studies concerning the efficacy of stent retrievers have been performed in large vessel occlusions of the anterior circulation, including only a few or single cases of BAO. [10][11][12][13][14][15][16][17] Furthermore, in the posterior circulation, proximal balloon occlusion for flow reversal during retrieval is not applicable.…”

Double Solitaire Mechanical Thrombectomy in Acute Stroke: Effective Rescue Strategy for Refractory Artery Occlusions?

“…6 In these refractory cases, different rescue treatments have been proposed with variable rates of success. 4,5,[7][8][9][10] These include local intra-arterial fibrinolysis, MT with the Penumbra device (Penumbra, Alameda, California), mechanical thrombus disruption, thromboaspiration through a distal-access catheter (DAC), balloon angioplasty, and/or stent placement.…”