Mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke in a Brazilian population

Abstract

OBJECTIVE:Large vessel occlusion in acute ischemic stroke is associated with low recanalization rates under intravenous thrombolysis. We evaluated the safety and efficacy of the Solitaire AB stent in treating acute ischemic stroke.METHODS:Patients presenting with acute ischemic stroke were prospectively evaluated. The neurological outcomes were assessed using the National Institutes of Health Stroke Scale and the modified Rankin Scale. Time was recorded from the symptom onset to the recanalization and procedure time. Recanalization was assessed using the thrombolysis in cerebral infarction score.RESULTS:Twenty-one patients were evaluated. The mean patient age was 65, and the National Institutes of Health Stroke Scale scores ranged from 7 to 28 (average 17±6.36) at presentation. The vessel occlusions occurred in the middle cerebral artery (61.9%), distal internal carotid artery (14.3%), tandem carotid occlusion (14.3%), and basilar artery (9.5%). Primary thrombectomy, rescue treatment and a bridging approach represented 66.6%, 28.6%, and 4.8% of the performed procedures, respectively. The mean time from symptom onset to recanalization was 356.5±107.8 minutes (range, 80-586 minutes). The mean procedure time was 60.4±58.8 minutes (range, 14-240 minutes). The overall recanalization rate (thrombolysis in cerebral infarction scores of 3 or 2b) was 90.4%, and the symptomatic intracranial hemorrhage rate was 14.2%. The National Institutes of Health Stroke Scale scores at discharge ranged from 0 to 25 (average 6.9±7). At three months, 61.9% of the patients had a modified Rankin Scale score of 0 to 2, with an overall mortality rate of 9.5%.CONCLUSIONS:Intra-arterial thrombectomy with the Solitaire AB device appears to be safe and effective. Large randomized trials are necessary to confirm the benefits of this approach in acute ischemic stroke.

Solitaire stent in the treatment of acute ischemic stroke with large cerebral artery occlusion

“…Incidence for the end of the event and determine recanalization of TICI classification standard and a large, prospective, multicenter, randomized, controlled study of SWIFT consistent [ 11 ], several studies have shown that stent supports bolt extraction for treatment of acute cerebral infarction caused by artery occlusion, specific and effective rate of blood vessels, can effectively save in ischemia half dark band of tissue cells, improve the clinical outcomes for patients with malignant cerebral infarction [ 12 - 15 ], preoperative diffusion and perfusion imaging, judging ischemia half the size of the dark band, and also carries on intravascular should decide whether the important basis [ 16 , 17 ]. A large meta-analysis showed that intravenous thrombolysis of the great vessels take rate less than 30%, however stents should be used to achieve TICI block blood vessels - 3 level was 93.3%, the rate of over 90 days [ 18 ].…”

Standard strategies for acute ischemic stroke within the rtPA therapeutic window

“…6,7 Stroke patients 80 years or older were allowed to receive the treatment under restricted conditions. 11 One may question whether the low-and middle-income countries are following the right pathway to the future of acute stroke treatment, chasing the boundaries of the therapeutic window using thrombolytic therapy with sophisticated imaging protocols and expensive recanalization tools affordable for few individuals. This was confirmed in a recent publication, where a significant proportion of elderly stroke patients received IV rtPA in a major Brazilian metropolitan area.…”

Comparison between the six-minute walk test and the six-minute step test in post stroke patients

“…It is also considered one of the main causes of disabilities [5] resulting not only in persistent neurological deficits, but also in a high physical deconditioning that propagates disability, leading to metabolic abnormalities that significantly increase the risk of myocardial infarction and recurrent stroke [6]. …”