RESUMO
Objective: To investigate the safety and efficacy of Solitaire stent combined with Navien aspiration for large vessel occlusion of anterior circulation performed in county comprehensive stroke centers. Methods: From March 2018 to December 2018, a total of 17 consecutive patients with large vessel occlusion of anterior circulation and treated with Solitaire stent combined with Navien catheter for mechanical thrombectory in Department of Stroke Center, the First People's Hospital of Taicang were retrospectively recruited. Among the 17 patients, 10 were males and 7 were females. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 8 to 22,with mean score 14 ±4. The occluded arteries included M1 segment of middle cerebral artery in 12 patients, bifurcation of middle cerebral artery in 1 patient and initial part of the internal carotid artery in 4 patients. Four patients were wake-up stroke and 1 patient was in-hospital stroke. The age, gender, onset-to-door time(ODT), door-toneedle time(DNT),door-to-puncture time(DPT), puncture-to-reperfusion time(PRT), changes of NIHSS score at 24 h after operation compared to preoperative baseline,successful recanalization of the Thrombolysis in Cerebral Infarction (TIG) classification 2b-3, operation-related complications and good prognosis of modified Rankin Scale (mRS) score ≤ 2 at day 90 after operation were all documented. Results: Among the 17patients,5 patients were treated with endovascular thrombectomy bridging with intravenous thrombolysis and 12 patients with endovascular thrombectomy alone. The ODT ranged 1. 0 -5. 5 h, with median 3.0 (2. 0,4. 7) h; the DNT ranged 26-35 min,with mean 30 ±4min; the DPT ranged 79-276 min,with mean 152 ±53 min; the PRT ranged 27-134 min, with mean 57 ±33 min. The thrombectomy ranged 1 - 3 times,with median 1(1,2) times. DSA examination was performed immediately after thrombectomy. Among 17 patients,2patients achieved TICI 2a,5 patients achieved TICI 2b and lOpatients achieved TICI 3. The rate of successful recanalization was 15/17. The rate of successful recanalization by one-time thrombectomy was 11/17. One patient showed distal occlusion and was recanalized after additional thrombectomy. No intracranial hemorrhage occurred. The postoperative NIHSS ranged 2-20points,with mean 9 ±5points and it was significantly different from that of preoperative NIHSS (t = 5. 759, P < 0. 05). Twelve patients had mRS score ≤ 2 at day 90 after operation, and the rate of good prognosis was 12/17. Conclusion: Solitaire stent thrombectomy combined with Navien catheter aspiration in county comprehensive stroke centers is safe and effective for large vessel occlusion of anterior circulation.
RESUMO
Objective To investigate the preliminary experience of mechanical thrombectomy with a tri-axial system of the Solitaire AB stent through a Neuro delivery catheter to treat intracranial large artery occlusion. Methods A tri-axial system was used to deliver the Solitaire AB stent through a Neuro delivery catheter to provide intracranial aspiration in close proximity to the stent. This technique was used in 1 case of acute middle cerebral artery occlusion and 1 case of acute basilar artery occlusion. Results Successful revascularization was achieved in these 2 cases. Thrombolysis in cerebral infarction (TICI)score was 3. The clot length of acute middle cerebral artery occlusion was 3 cm and the modified Rankin Scale (mRS)score of this case was 3 at 90 days follow-up. Another patient with acute bilateral vertebral occlusion was revealed successful recanalization by angiography. Conclusion The results suggest that this technique of a tri-axial system used of the Solitaire stent through a Neuro delivery catheter can effectively retrieve clots from the occlusive artery and minimize the chance of antegrade blood flow dislodging the thrombus.