Mechanical thrombectomy in severe acute stroke: preliminary results of the Solitaire stent: Table 1

Mpotsaris, Anastasios; Bußmeyer, Matthias; Loehr, Christian; Oelerich, M.; Büchner, Helmut; Weber, W.

doi:10.1136/jnnp.2010.225573

Cited by 43 publications

(19 citation statements)

References 5 publications

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“…57,58 The two subgroups of endovascular thrombectomy and endovascular thromboaspiration (represented by the MERCI Retriever and Penumbra System respectively) accounted for a large proportion of the available data (n = 29, 63% and n = 13, 28%). Of the 46 studies, most (78%) were published in full text, [14][15][16][17][18][19][20][22][23][24][25][28][29][30][31][32][33][34][35][36][37][40][41][42][43][44][45][46]48,49,[52][53][54][55][56][57][58] while the remainder (22%) were available in abstract only. 13,18,21,26,27,38,39,47,50,51 Most studies enrolled pat...…”

Section: Resultsmentioning

confidence: 99%

“…The ICH (symptomatic and asymptomatic) rates were reported in 38 studies that included 330 of 1277 patients (25.7%), and the ICH rates of the four groups were 31.3%, 18.4%, 11.8%, and 20.9%, respectively. With regard to endovascular thrombectomy, the ICH rates ranged from 0% to 46% with the MERCI Retriever, [13][14][15][16][17][18][19][20][21][22][23][24][25] 0% to 40% with the Solitaire stent [34][35][36][37][38][39][40][41] and 0% to 29% with the other four devices. [26][27][28][29][30][31][32][33] For endovascular thromboaspiration, the ICH rates were 0% to 44% with Penumbra System 42-53 and 30% with the AngioJet catheter.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, recanalization was achieved in 1125 of 1530 patients (73.5%), which included endovascular thrombectomy (67.3%), endovascular thromboaspiration (82.1%), laser thrombolysis (41.7%), and ultrasonification (65.1%). As far as endovascular thrombectomy is concerned, the recanalization rates ranged from 43% to 88% with the MERCI Retriever, [13][14][15][16][17][18][19][20][21][22][23][24][25] 86% to 100% with the Solitaire stent, [34][35][36][37][38][39][40][41] and 60% to 100% with the other four devices. [26][27][28][29][30][31][32][33] For endovascular thromboaspiration, the recanalization rates were 67% to 100% with the Penumbra System, [42][43][44][45][46][47][48][49][50][51][52][53] For laser thrombolysis, the recanalization rates were 41% with EPAR, 55 and 50% with the LaTIS laser device.…”

Section: Resultsmentioning

confidence: 99%

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Neurothrombectomy for the treatment of acute ischemic stroke in 1530 patients

Zhang

Yang

et al. 2012

Journal of Clinical Neuroscience

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Neurothrombectomy for the treatment of acute ischemic stroke in 1530 patients

Zhang

Yang

et al. 2012

Journal of Clinical Neuroscience

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“…Stent retrievers offer three potential advantages over other retrieval devices: (i) restoration of flow immediately upon deployment within the target artery, rather than only upon successful clot extraction, (ii) substantially higher successful recanalisation rates than other embolectomy devices, and (iii) the option to detach the stent and leave it in place in the vessel if the thrombus is unable to be withdrawn. In single centre series, retrievable stents have achieved rapid and frequent flow restoration [89,90]. Several multicentre trials comparing stent retrievers with earlier generation devices are under way.…”

Section: Endovascular Retrieval Devicesmentioning

confidence: 99%

Improving reperfusion therapy for acute ischaemic stroke

Saver

2011

Journal of Thrombosis and Haemostasis

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Summary. Background: The first generation of clinical reperfusion treatment, intravenous (IV) fibrinolysis with tissue plasminogen activator (tPA), was a transformative breakthrough in stroke care, but is far from ideal. Objectives: To survey emerging strategies to increase the efficacy and safety of cerebral reperfusion therapy. Methods: Narrative review. Results and Conclusions: Innovative IV pharmacologic reperfusion strategies include: extending IV tPA use to patients with mild deficits; developing novel fibrinolytic agents (tenecteplase, desmetolplase, plasmin); using ultrasound to enhance enzymatic fibrinolysis; combination clot lysis therapies (fibrinolytics with GPIIb/IIIa agents or direct thrombin inhibitors); co‐administration of MMP‐9 inhibitors to deter haemorrhagic transformation; and prehospital neuroprotection to support threatened tissues until reperfusion. Endovascular recanalisation strategies are rapidly evolving, and include intra‐arterial fibrinolysis, mechanical clot retrieval, suction thrombectomy, and primary stenting. Combined approaches appear especially promising, using IV fibrinolysis to rapidly initiate reperfusion, mechanical endovascular treatment to debulk large, proximal thrombi, and intra‐arterial (IA) fibrinolysis to clear residual distal thrombus elements and emboli.

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“…[23][24][25][26][27][28][29][30][33][34][35][36][37][38][39][40][41][42][43][44][45][46] If we summarize the data from the studies listed in the table, the average recanalization rate is 93.3% to achieve a TICI 2-3/TIMI 2-3 score in a mean of 1.8 passes. Favorable outcome, as measured by mRS score of 0 -2, was achieved in 49.2% of patients at 90 days, with an average mortality rate of about 17.4%.…”

mentioning

confidence: 99%

Retrievable stents, “stentrievers,” for endovascular acute ischemic stroke therapy

et al. 2012

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Endovascular therapy for acute ischemic stroke continues to evolve to improve both efficacy and safety. In the late 1990s, intra-arterial chemical thrombolysis with prourokinase was shown to be effective in achieving partial recanalization and improving clinical outcome, in comparison with intra-arterial heparin administration. However, this was at the expense of an increase in the rate of symptomatic intracranial hemorrhage to 10%. To improve the rate of recanalization, expand the time window, and reduce the risk of symptomatic intracranial hemorrhage, mechanical thrombectomy was introduced, with initial approval of the Merci clot retriever, a corkscrew-like device, and then more recently with approval of the Penumbra thromboaspiration system. Both devices are associated with a high rate of recanalization (total, partial, and complete). However, time to recanalization was on average 45 minutes, with a low rate of complete clot resolution, given that the majority of patients achieved only partial recanalization. More recently, retrievable stents have shown promise in reducing the time to recanalization, and they achieve a higher rate of complete clot resolution with improved feasibility. The retrievable stent can be opened within the clot to engage it within the stent struts, and subsequently it is retrieved by pulling it under flow arrest. The retrievable stents provide a new tool in the armamentarium of devices that can be used to achieve safe and timely clot removal. This review provides the historical evolution of endovascular therapy to use of stentreivers. Neurology ® 2012;79 (Suppl 1):S148-S157 GLOSSARY AIS ϭ acute ischemic stroke; CI ϭ confidence interval; ECASS ϭ European Cooperative Acute Stroke Study; FDA ϭ US Food and Drug Administration; IA ϭ intra-arterial; ICA ϭ internal carotid artery; ICH ϭ intracerebral hemorrhage; IMS ϭ Interventional Management of Stroke; MCA ϭ middle cerebral artery; mRS ϭ modified Rankin Scale; NIHSS ϭ NIH Stroke Scale; NINDS ϭ National Institute of Neurological Disorders and Stroke; OR ϭ odds ratio; PROACT ϭ Prolyse in Acute Cerebral Thromboembolism; RSs ϭ retrievable stents; rtPA ϭ recombinant tissue plasminogen activator; SESs ϭ self-expanding stents; SWIFT ‫؍‬ Solitaire FR With the Intention for Thrombectomy; TICI ϭ thrombolysis in cerebral ischemia; TIMI ϭ thrombolysis in myocardial infarction.Acute ischemic stroke (AIS) therapy is based on the concept that early recanalization of the occluded artery leads to improved clinical outcome through preservation of the time-sensitive penumbra.1-3 There has been an evolution in the development of techniques used to achieve faster and safer rates of recanalization. Because of the limited efficacy of pharmacologic thrombolysis, mechanical and multimodality methods have been sought to aid revascularization of the occluded artery. A newer endovascular approach using retrievable stents (RSs) shows promising results for better and faster rates of recanalization with possibly better shortterm outcomes.

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Mechanical thrombectomy in severe acute stroke: preliminary results of the Solitaire stent: Table 1

Cited by 43 publications

References 5 publications

Neurothrombectomy for the treatment of acute ischemic stroke in 1530 patients

Neurothrombectomy for the treatment of acute ischemic stroke in 1530 patients

Improving reperfusion therapy for acute ischaemic stroke

Retrievable stents, “stentrievers,” for endovascular acute ischemic stroke therapy

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