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

Abstract

BACKGROUND AND PURPOSE:Acute BAO is a devastating neurological condition associated with a poor clinical outcome and a high mortality rate. Recanalization has been identified as a major prognostic factor for good outcome in BAO. Mechanical thrombectomy using retrievable stents is an emerging treatment option for acute stroke. First clinical trials using stent retrievers have shown promising high recanalization rates. However, these studies mainly included large artery occlusions in the anterior circulation with only a few or single cases of BAO. Therefore, the purpose of this study was to evaluate technical feasibility, safety, and efficacy of mechanical thrombectomy using retrievable stent in the treatment of acute BAO.

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

“…Recent studies with the use of mechanical thrombectomy with stent retrievers reported significantly increased recanalization rates ranging from 74 -100% in patients with acute BAO. [12][13][14] In our study, we achieved successful recanalization (TICI grades 2b to 3) in 96% (24/25) of patients, which is in line with previous reports. Successful recanalization with only the Solitaire stent occurred in 84% (21/25) of patients.…”

“…[12][13][14] In contrast to our study, these previous studies included patients treated within 24 hours of stroke symptom onset. In a series of 14 patients treated with a Solitaire thrombectomy, Mordasini et al 12 reported that 28.6% (4/14) had a good outcome (mRS 0 -2), and the mortality rate was 35.7% (5/14). In their study, a Solitaire thrombectomy was not the first-line endovascular treatment, and the median time from symptom onset to first angiogram was 414 minutes (range, 176 -1440 minutes).…”

“…The efficacy of stent retrievers for treating acute BAO was reported in several recent case series. [12][13][14] These previous studies used a longer time window of up to 24 hours for mechanical thrombectomy in patients with acute BAO. However, BASICS showed that early recanalization therapy in patients with acute BAO is associated with a more favorable outcome, and all patients with severe stroke treated Ͼ9 hours after symptom onset had poor functional outcome despite IV or IA thrombolysis.…”

Flat Detector Angio-CT following Intra-Arterial Therapy of Acute Ischemic Stroke: Identification of Hemorrhage and Distinction from Contrast Accumulation due to Blood-Brain Barrier Disruption

“…The Solitaire endovascular device has proved to be a valid tool in the treatment of acute ischemic stroke, providing effective and relatively safe arterial recanalization. 11,12,21,22 In our study of FPCT after endovascular stroke treatmentwith IV bridging thrombolysis in 10%, intra-arterial thrombolysis in 56%, and mechanical thrombectomy in 81% of patients-an intracranial hematoma was present in 16% of all cases. While most ICB (5% of patients) was found to be a clinically less relevant hemorrhagic transformation, parenchymal hematoma was a rare incident (4%); however, it was combined with SAH in all 3 cases.…”

Diffusion-Weighted Imaging Score of the Brain Stem: A Predictor of Outcome in Acute Basilar Artery Occlusion Treated with the Solitaire FR Device

“…3 Early recanalization remains the main important factor that can improve outcome. [4][5][6] However, even though the best recanalization rate is achieved by using a newer stent retriever, such as a Solitaire FR Device (Covidien, Irvine, California) (up to 100%), [7][8][9][10] stent retriever impact on functional outcome is not as clear-cut as expected and has not been documented in a randomized trial. The extent of baseline brain stem ischemic damage can also influence outcome.…”