Safety and Efficacy of Mechanical Thrombectomy with Solitaire Stent Retrieval for Acute Ischemic Stroke: A Systematic Review

Abstract

PurposeIn recent years, mechanical thrombectomy using Solitaire stent retrieval has been tried for treating acute ischemic stroke with a large artery occlusion. We systematically reviewed published articles to appraise the evidence that supports the safety and efficacy of the mechanical thrombectomy in acute strokes with Solitaire stent.Materials and MethodsSystematic searches using Medline and Scopus were performed for studies evaluating mechanical thrombectomy using a Solitaire stent in acute ischemic stroke. Articles were included if they were published since 2008, contained at least 5 subjects, and provided clinical results.ResultsThirteen articles (262 cases) were included in this review. The mean time of the procedures ranged from 37 to 95.6 minutes in 10 studies. The success of recanalization was achieved in 89.7% and the recanalization rate varied from 66.7% to 100% in all 13 studies. The overall rates of the symptomatic hemorrhagic complications and mortality were 6.8% and 11.1%, respectively. A favorable outcome of mRS 2 or under was 47.3%. Procedure-induced complications developed in 3.4%.ConclusionThe present review suggested that mechanical thrombectomy using a Solitaire stent in acute ischemic stroke was effective in recanalizing the occluded artery. The rate of procedural complications was small.

Safety and efficacy of mechanical thrombectomy with Solitaire in patients with acute ischemic stroke

“…[13] We had successful recanalization (TICI 2 and TICI 3) in 14 (87.5%) of our patients, similar to the rates reported by Koh et al [14] In two patients with ICA occlusion, recanalization was unsuccessful after repeated attempts. In one of them, we tried balloon angioplasty after repeated attempts with solitaire but finally flow could not be established.…”

Guidelines for acute ischemic stroke treatment: part II: stroke treatment

“…Examples include the Solitaire and Trevo devices. In a recent meta-analysis of 30 observational studies 63 with 262 acute stroke patients treated with the Solitaire device, successful recanalization was achieved in 90% of cases (range, 67-100%). The rates of symptomatic hemorrhagic complications and mortality were 7 and 11%, respectively, and functional independence (mRS 0 to 2) was achieved by 47% of patients.…”

Endovascular Therapy in Hyperacute Ischaemic Stroke: History and Current Status

“…a systematic review of published series using the Solitaire device (ev3 neurovascular, Irvine, California, USa) demonstrated a recanalisation rate of 89.7% and a favourable outcome (mRS 0-2) in 47.2% of 262 patients 61 . Multiple series have subsequently been published [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77] (see table 8 for series of at least 30 patients).…”

“…Multiple series have subsequently been published [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77] (see table 8 for series of at least 30 patients). Independent outcomes (mRS 0-2 at 90 days) are now reported in approximately 55% (42.5-77%) [60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77] in those with lvo with moderate/severe strokes. this relatively wide range likely reflects Key criticisms: 1) Most in the Evt arm received two thirds of the total dose of Iv tpa and were therefore disadvantaged (especially if no Evt was then undertaken).…”