Subarachnoid Hemorrhage in a Multimodal Approach Heavily Weighted Toward Mechanical Thrombectomy With Solitaire Stent in Acute Stroke

Abstract

Background and Purpose-Subarachnoid hemorrhage (SAH) may appear on computerized tomography scans after mechanical thrombectomy for acute ischemic stroke. The incidence and prognosis of this observation remain unknown. We investigated the frequency and clinical consequences of SAH after treating acute ischemic stroke with a multimodal approach heavily weighted toward mechanical thrombectomy with Solitaire stent. Methods-Seventy-four consecutive patients with acute ischemic stroke underwent mechanical thrombectomy with a Solitaire stent as a first-line treatment. Nonenhanced computerized tomography scans were performed before, immediately after, and 24 hours after treatment to detect SAH. Clinical outcome was assessed after treatment, on day 1, at discharge, and at 3 months. Clinical and radiological data were compared between patients with and without SAH. Results-Twelve patients (16.2%) exhibited SAH associated with pure SAH (n=4) or mixed SAH and contrast extravasation (n=8). The SAH was located in the ipsilateral Sylvian fissure (n=11) or bilateral parietooccipital sulci (n=1). Patients with SAH had no periprocedural vessel perforations or arterial dissections and no postprocedural neurological deteriorations.Rescue angioplasty was performed more frequently in SAH group than in control group (33.3% vs 9.7%; P=0.05).Patients with SAH and those without had similar recanalization rates and clinical outcomes. Conclusions-SAH on post-therapeutic computerized tomography scans were not uncommon after primary mechanical thrombectomy with a Solitaire stent, but they seemed to be benign. Rescue angioplasty and unidentified, small vessel ruptures due to mechanical stretch during stent retrieval might give rise to these lesions. (Stroke. 2013;44:414-419.)

Acute Basilar Artery Occlusion: Outcome of Mechanical Thrombectomy with Solitaire Stent within 8 Hours of Stroke Onset

“…A recent study suggested that SAH might occur after mechanical thrombectomy with the Solitaire stent because of angiographically occult ruptures of small vessels caused by mechanical stretch during stent retrieval and that this had a benign clinical course. 23 Mordasini et al 12 reported no device-related complications or symptomatic hemorrhage. Espinosa de Rueda et al 13 reported 1 SAH in 18 patients with BAO treated with primary mechanical thrombectomy with the Solitaire stent.…”

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: A Multicenter Retrospective Observational Study

“…The choice of technique was left to the discretion of the treating neurointerventionist. The details of these thrombectomy techniques were described previously 11, 12, 13. When the selected first‐line thrombectomy technique failed to achieve successful reperfusion, the neurointerventionist switched to the other technique.…”

Histologic Analysis of Retrieved Clots in Acute Ischemic Stroke: Correlation with Stroke Etiology and Gradient-Echo MRI

“…The details of the techniques used for stent-based thrombectomy and manual aspiration thrombectomy were previously described. 5,14 Revascularization status was assessed on the final angiogram and was classified according to the modified TICI scale, 15 and successful revascularization was defined as a modified TICI grade of 2b or 3. Clinical outcome was assessed by a stroke neurologist by using the mRS during an outpatient visit 3 months after treatment.…”