Double Solitaire Mechanical Thrombectomy in Acute Stroke: Effective Rescue Strategy for Refractory Artery Occlusions?

BACKGROUND AND PURPOSE:Mechanical thrombectomy by using a single stent retriever system has demonstrated high efficacy for recanalization of large-artery occlusions in acute stroke. We aimed to evaluate the feasibility, safety, and efficacy of a novel double Solitaire stent retriever technique as an escalating treatment for occlusions that are refractory to first-line single stent retriever mechanical thrombectomy.MATERIALS AND METHODS:All patients treated with the double stent retriever technique by using the Solitaire system were retrospectively selected from 2 large neurointerventional centers. Time to recanalization, angiographic (TICI) and clinical outcomes (mRS), and complications were assessed.RESULTS:Ten patients (median NIHSS score, 16; mean age, 70 years) with MCA M1 segment (n = 5) and terminal ICA (n = 5 including 2 ICA tandem) occlusions were included. Prior single stent retriever mechanical thrombectomy had been performed in 9 patients (median number of passes, 3). Median time to recanalization was 60 minutes (interquartile range, 45–87 minutes). Procedure-related complications occurred in 1 patient; overall mortality was 20%. Recanalization of the target vessel (TICI 2b/3) was achieved in 80%. Good clinical outcome (mRS 0–2) was 50%.CONCLUSIONS:In this preliminary feasibility study, the double Solitaire stent retriever technique proved to be an effective method for recanalization of anterior circulation large-artery occlusions refractory to standard stent retriever mechanical thrombectomy.

In acute ischemic stroke, recanalization of an occluded cerebral artery is strongly linked with improved clinical outcome and reduced mortality.¹ The potential of IV thrombolysis for achieving successful vessel recanalization is significantly limited by the extent of clot burden in proximal cerebral artery occlusions.² With the recent introduction of stent retrievers (SR) for mechanical thrombectomy (MT), fast, safe, and efficient large-artery recanalization treatment can be achieved, and their superiority over older MT devices has been demonstrated in randomized controlled trials.^3,4Despite considerable recanalization rates of 61%–86% (Thrombolysis in Myocardial Infarction/TICI scores of ≥2/2b),^3–5 up to 33.3% of patients are still left without sufficient recanalization after standard SR MT.⁶ In these refractory cases, different rescue treatments have been proposed with variable rates of success.^4,5,7–10 These include local intra-arterial fibrinolysis, MT with the Penumbra device (Penumbra, Alameda, California), mechanical thrombus disruption, thromboaspiration through a distal-access catheter (DAC), balloon angioplasty, and/or stent placement.Here, we describe a novel escalating strategy for MT by using 2 Solitaire SR devices (Covidien, Irvine, California), hence termed the “double Solitaire SR technique,” for proximal anterior circulation occlusions that are refractory to first-line single SR MT. In a retrospective series of patients from 2 large neurointerventional centers, we assessed the feasibility, safety, and angiographic and clinical outcomes of this technique.     

Safety of the Solitaire 4 × 40 mm Stent Retriever in the Treatment of Ischemic Stroke

CardioVascular and Interventional Radiology - Stent retrievers apply mechanical force to the intracranial vasculature. Our aim was to evaluate the safety and efficacy of the long Solitaire...     

Coil embolization of anterior circulation aneurysms supported by the Solitaire™ AB Neurovascular Remodeling Device

Introduction

The purpose of the study is to evaluate patients with wide-necked or complex aneurysms of the anterior circulation who underwent Solitaire? AB Neurovascular Remodeling Device-assisted coil embolization.

Methods

From February 2008 to March 2009, consecutive data were collected from 45 patients with anterior circulation aneurysms. Eighteen of the patients presented with acute subarachnoid hemorrhage. Forty-six aneurysms were treated with the aid of different applications (n?=?49) of the Solitaire? AB Remodeling Device followed by standard coiling procedure (n?=?43) using bioactive coils or/and bare coils.

Results

Successful positioning of the remodeling device was obtained in 95.9% of the cases. There were two thromboembolic complications (4.1%) and one severe vasospasm requiring retrieval of the device. Permanent procedural morbidity was observed in one patient (2%). The proportion of patients in whom Raymond class 1 occlusion was obtained was 53.5% (n?=?23). Raymond class 2 occlusion was achieved in 42% (n?=?18) and Raymond class 3 occlusion in 4.7% (n?=?2). Thirty-nine patients left the hospital with a good clinical status.

Conclusion

The initial technical and clinical results of Solitaire? AB device-assisted coiling of aneurysms in the anterior circulation are highly encouraging. This technique may enhance the possibilities of the endovascular treatment of these aneurysms in clinical routine.     

Waffle-cone technique with Solitaire™ AB Remodeling Device: endovascular treatment of highly selected complex cerebral aneurysms

Introduction  

To evaluate patients with complex aneurysms who underwent waffle-cone stent-assisted coil embolization.     

Stent-assisted coil embolization of intracranial aneurysms using the Solitaire™ AB Neurovascular Remodeling Device: initial and midterm follow-up results

Introduction

The purpose of this retrospective review was to present our experience in using the Solitaire? AB Neurovascular Remodeling Device in the stent-assisted treatment of intracranial aneurysms, focusing on midterm results. To date, this is the largest series using the Solitaire? AB Neurovascular Remodeling Device.

Methods

From February 2008 to December 2010, 102 patients harboring 104 wide-necked or complex intracranial aneurysms were consecutively enrolled. Forty-five patients presented with an acute subarachnoid hemorrhage. Stent implantation was combined with a standard coiling procedure in 100 patients; in 13 of them, by bailout stenting. On average, at least one clinical and angiographic follow-up was available in 63 patients after 6.3 months. Forty-nine patients were followed for up to 13.6 months.

Results

Of the stents, 98.4 % could be deployed successfully. A Raymond class 1 occlusion was obtained in 51 % of the aneurysms, a Raymond class 2 occlusion in 44 %, and in the remaining 5 % a Raymond class 3 occlusion was obtained. Procedure-related morbidity was 3.9 % (n?=?4) and procedure-related mortality was 2.9 % (n?=?3). During the follow-up period, 39.2 % of the aneurysms showed further thrombosis, 45.1 % remained unchanged, and 15.7 % recanalized. In the follow-up clinical examination according to the modified Rankin Scale, 16.3 % of all patients presented with clinical improvement, 73.5 % were unchanged, and 10.2 % of patients deteriorated.

Conclusion

Considering that stent-assisted coiling is indicated in unfavorable aneurysms, which are not amenable to standard coiling procedures, the Solitaire AB stent proved to be an efficient and safe device in midterm angiographic and clinical follow-up results.     

Carotid Artery Stent Placement and Carotid Endarterectomy: A Challenge for Urgent Treatment after Stroke—Early and 12-Month Outcomes in a Comprehensive Stroke Center

Purpose

To compare feasibility, 12-month outcome, and periprocedural and postprocedural risks between carotid artery stent (CAS) placement and carotid endarterectomy (CEA) performed within 1 week after transient ischemic attack (TIA) or mild to severe stroke onset in a single comprehensive stroke center.