Treatment of acute middle cerebral artery occlusion with a Solitaire AB stent: preliminary experience

Abstract

ABSTRACT. We report our initial experience with a Solitaire AB neurovascular remodeling stent device in performing cerebral embolectomy in seven patients presenting to our institution with acute stroke who were resistant to iv thrombolytic drug treatment. The main inclusion criteria were: National Institutes of Health Stroke Scale (NIHSS) score >10; treatment performed within 8 h from the onset of symptoms and no large hypodensity on CT; and occlusion of a major cerebral artery on the CT angiogram. An admission and a post-interventional NIHSS score were calculated for all patients by two different neurologists. Efficacy was assessed radiologically by posttreatment thrombolysis in myocardial infarction (TIMI) scores and clinically by a 30-day Modified Rankin Scale (MRS) score. The mean duration of neurointerventional treatment was 84 min. All interventions were successful, with TIMI scores of 2 or 3 achieved in 100% of patients. There was one procedural complication in our series owing to a self-detached stent and one patient had a small asymptomatic basal ganglia haemorrhage. There was improvement of more than 4 points on the NIHSS score in 5 (72%) of the patients following treatment, of whom 4 (57%) had a 30-day MRS score of #2. The use of a Solitaire stent in acute stroke was safe, time-efficient and encouraging; however, a larger sample size will be required to further evaluate the use of this device, which could benefit a significant number of stroke patients.

Comparison of Stent-Retriever Devices versus the Merci Retriever for Endovascular Treatment of Acute Stroke

“…In several single-center studies, promising results for the Solitaire device have been reported. 24,25 In the United States, the SOLITAIRE FR With the Intention For Thrombectomy Study is now ongoing, aiming to demonstrate substantial equivalence of the Solitaire device to the Merci device.…”

Potential for the Use of the Solitaire Stent for Recanalization of Middle Cerebral Artery Occlusion without a Susceptibility Vessel Sign

“…[4][5][6][7][8]20,21 However, it is unknown whether the Solitaire stent could be used as a thrombectomy device and could be effective in recanalizing an in situ steno-occlusive lesion. In this study, we performed multimodal endovascular recanalization therapy by using the Solitaire stent as a first-line device for 38 MCA occlusions, and 11 MCA occlusions (28.9%) were verified as not showing the MCA SVS on GRE MR imaging.…”

“…Several case series describing thrombectomy by using the Solitaire stent have reported successful recanalization, with a success rate between 62% and 100%. [4][5][6][7][8]20,21 However, the first multicenter, prospective, randomized trial for the Solitaire system (the Solitaire With the Intention For Thrombectomy [SWIFT] trial) showed that successful recanalization (Thrombolysis in Myocardial Infarction grade 2 or 3) without symptomatic intracranial hemorrhage was achieved in 61% of the Solitaire group. 8 Thus, our results do not appear to be worse than those of the SWIFT trial.…”

“…Many reputable studies have shown that entrapping and extracting the thromboembolus by using the Solitaire stent is fast and effective in vascular recanalization, especially when treating large arterial occlusions, including MCA occlusion. [4][5][6][7][8] Thromboembolus in the MCA is known to create the MCA susceptibility vessel sign (SVS) on gradient recalled-echo (GRE) MR imaging. 9,10 This sign results from a T2-shortening effect of intracellular deoxyhemoglobin in the acute stage of a red blood cell clot.…”

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

“…[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%.…”