The correlation between serum microRNA-124 and microRNA-181c expression and the treatment outcome of Solitaire stent thrombectomy in patients with acute cerebral infarction and analysis of influencing factors / 中国医师进修杂志

Objective:To explore the correlation between serum microRNA(miR)-124 and miR-181c expression and the treatment outcome of Solitaire stent thrombectomy in patients with acute cerebral infarction and its influencing factors.Methods:Eighty-one patients with acute cerebral infarction performed Solitaire stent thrombectomyfrom June 2018 to October 2020 in the Affiliated Hospital of Jining Medical College were selected. The predictive value of miR-124, miR-181c expression in patients with acute cerebral infarction were analyzed.Results:In 81 patients, 21 patients with poor outcome(poor outcome group) and 60 patients with favorable outcome (favorable outcome group). The ratio of age ≥ 60 years in poor outcome group was higher than that in the favorable outcome group: 76.19% (16/21) vs. 46.67% (28/60), there was statistical difference ( χ2 = 5.46, P<0.05). The levels of miR-124, miR-181c before surgery and postoperative 1-day, 7-day in the favorable outcome group were higher than those in poor outcome group: 2.81 ± 0.82 vs. 2.24 ± 0.74, 3.01 ± 1.52 vs. 2.07 ± 1.04, 3.25 ± 1.67 vs. 1.86 ± 0.92; and the levels of miR-181c before surgery and postoperative 1-day, 7-day in the favorable outcome group were lower than those in the poor outcome group: 1.43 ± 0.59 vs. 1.79 ± 0.65, 1.35 ± 0.62 vs. 1.94 ± 0.79, 1.24 ± 0.60 vs. 2.16 ± 1.08, there were statistical differences ( P<0.05). The results of Logistic multivariate analysis showed that the age, the levels of miR-124, miR-181c before operation and postoperative 1-day, 7-day were influencing factors for the treatment outcome of Solitaire stent thrombectomy. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve of miR-124, miR-181c on the postoperative 7-day were 0.806, 0.861, and were higher than those before operation and the postoperative 1-day, the diagnostic sensitivity were 71.43%, 76.19%, the specificity were 88.33%, 85.00%. Conclusions:The expression of miR-124 and miR-181c in the serum of acute cerebral infarction is related to the outcome of Solitaire stent thrombectomy, especially the expression level on the postoperative 7-day has better application value. It can be used to predict the outcome of surgery.

[Treatment efficacy of Solitaire stent- and LVIS stent-assisted coil embolization for intracranial wide-neck carotid aneurysm].

OBJECTIVE: To compare the safety, efficacy and complications of LVIS stent-assisted coil embolization and Solitaire stent-assisted coil embolization for management of intracranial wide-neck carotid aneurysms. METHODS: We retrospectively analyzed the data of 86 patients with intracranial wide-neck carotid aneurysm treated in our hospital between June, 2016 and June, 2019. Forty-three of the patients received LVIS stent-assisted coil tamponade and the other 43 received Solitaire stentassisted coil tamponade. Arteriography was performed during, immediately after, and at 3 months after the surgery. The immediate embolization rate, surgical complications (vascular spasm, acute thrombus, coil escape, and bleeding), and the recurrence rate were compared between the two groups. RESULTS: In the LVIS stent group, 37 aneurysms were completely embolized, 5 were nearly fully embolized, and 1 was partially embolized, as compared with the numbers of 35, 6, and 2 in the Solitaire stent group, respectively. Surgery-related complications occurred in 5 patients in LVIS stent group and 3 in Solitaire stent group. Follow-up digital subtraction angiography (DSA) at 3 months after the operation revealed 4 recurrent aneurysms, including 1 in LVIS group and 3 in Solitaire stent group. All the patients had favorable outcomes that did not differ significantly between the two groups. CONCLUSIONS: Stent-assisted spring coils can achieve a high rate of complete and near-total embolization for intracranial aneurysms and is associated with a low incidence of neurological complications and favorable prognosis of the patients. The embolization rate, complications and recurrence rate are comparable between LVIS stent and Solitaire stent.

Onset to reperfusion time as a determinant of outcomes across a wide range of ASPECTS in endovascular thrombectomy: pooled analysis of the SWIFT, SWIFT PRIME, and STAR studies.

BACKGROUND: The time-benefit relationship of endovascular thrombectomy (EVT) according to the size of the core infarct has been incompletely explored in prior studies. We investigated whether established infarct core size on baseline imaging modifies the relationship between onset-to-reperfusion time (OTR) and functional outcomes in patients with acute ischemic stroke treated with EVT. METHODS: We analyzed a database containing individual patient data pooled from three prospective Solitaire stent retriever studies. The inclusion criteria were treatment with a Solitaire device and achievement of substantial reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3). Main analyses were performed in patients with baseline Alberta Stroke Program Early CT Scores (ASPECTSs) of 7-10. RESULTS: Among the 305 patients (mean age 67±13 years, 58% women), the proportions of patients in different categories of pretreatment infarct extent were: small (ASPECTS 9-10) 52.0%, moderate (ASPECTS 7-8) 37.1%, and large (ASPECTS 0-6) 7.6%. The mean OTR was 297±95 min. At 3 months, 60.1% of the patients achieved a good outcome. For OTRs of 2-8 hours, the rates of good outcomes at all time points were higher with higher baseline ASPECTS but declined with similar steepness. Both baseline ASPECTS (OR 1.23 (95% CI 1.04 to 1.45)) and OTR (every 30 min delay, OR 0.80 (95% CI 0.73 to 0.88)) were independently associated with a good 3-month outcome. No interaction between OTR and baseline ASPECTS was observed. CONCLUSIONS: Although patients with higher baseline ASPECTS are more likely to have good clinical outcomes at all OTR intervals after 2 hours, this benefit consistently declines with time, even in patients with a small infarct core, reinforcing the need to treat all patients as quickly as possible.

Efficacy of mechanical thrombectomy with Solitaire stent in acute basilar artery occlusion: an analysis of 5 cases / 中华神经医学杂志

Objective To explore the efficacy and safety of mechanical thrombectomy with Solitaire device in patients with acute basilar artery occlusion (ABAO).Methods The clinical data of 5 patients with ABAO,underwent mechanical thrombectomy with Solitaire stent in our hospital from May 2016 to November 2018,were analyzed retrospectively.The clinical treatment efficacy and safety were recorded.Results All these 5 patients accepted endovascular mechanical thrombectomy successfully;successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] grading 2b or 3) was achieved in 4 patients;the embolus was detached to the distal arteriole in one patient.There was no symptomatic intracranial hemorrhage;one patient accepted decompressive craniectomy resulting from massive infarction of cerebellum.Follow up results 90 d after treatment indicated that 4 patients enjoyed good prognosis (modified Rankin Scale scores:0-3).Conclusion Mechanical thrombectomy with Solitaire device is suggested to be safe and efficient in ABAO patients complying with appropriate operative indications.

Evaluation of the Partial Re-Sheathing Technique with the Solitaire Stent Retrieval System In Vitro Model and a Representative Case.

Objective: Vascular injuries are severe complications associated with endovascular thrombectomy. In the present study, we evaluated the re-sheathing technique with the Solitaire stent retrieval system to overcome these complications. Methods: We examined the diameter and resistance to retrieval of the Solitaire FR device (6 × 20 mm) during full and partial deployment in vitro model. We also examined a representative case in which the re-sheathing technique was used. Results: We found that the Solitaire device spread elliptically during partial deployment. As the length of the partially deployed device decreased, the maximum diameter also decreased. The distal half of the stent retained 80% of the maximum diameter of the partially deployed Solitaire. The resistance to retrieval was significantly higher during full deployment (mean ± standard deviation; 0.32 ± 0.04 kg) than during half deployment (0.22 ± 0.04 kg) (Mann-Whitney U test; p = 0.006). The re-sheathing technique was used in the representative case due to the high resistance to retrieval, which enabled recanalization without extravasation. Conclusion: In cases of high resistance to retrieval, minimal re-sheathing may be useful for capturing the thrombus without increasing the risk of vascular injury.

Intravenous Administration of Standard Dose Tirofiban after Mechanical Arterial Recanalization is Safe and Relatively Effective in Acute Ischemic Stroke.

To investigate the safety and efficacy of intravenous administration of a standard dose of glycoprotein-IIb/IIIa inhibitor tirofiban after vessel recanalization by mechanical thrombectomy in acute ischemic stroke. A consecutive series of patients (n=112) undergoing endovascular ischemic stroke intervention therapy were enrolled. 81 patients were eligible for intravenous (IV) tirofiban treatment for 24 hours after mechanical thrombectomy. The incidence of symptomatic intracranial hemorrhage (sICH), death, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) were assessed. In the 81 patients receiving tirofiban, 52 patients (64.2%) were treated with IV rt-PA before mechanical thrombectomy. sICH was found in 2 (2.5%) patients with no fatal ICH. Four patients died during 3 months after stroke onset. Successful recanalization with thrombolysis in cerebral infarction (TICI) score ≥2b was achieved in 75 of 81 patients (92.6%) after mechanical thrombectomy. The average number of passes with Solitaire stent retriever was 1.3. At 3 months, 55 of 81 patients (67.9%) had favorable outcomes (mRS<=2). The intravenous application of a standard dose of tirofiban post-Solitaire stent retriever thrombectomy and intravenous thrombolysis appears to be safe and relatively effective in acute ischemic stroke.

Efficacy and safety of a direct aspiration first -pass thrombectomy technique in treating atherosclerotic acute intracranial large vessel occlusion / 中华神经医学杂志

Objective To investigate the efficacy and safety of a direct aspiration first-pass thrombectomy (ADAPT) technique in treating acute atherosclerotic intracranial large vessel occlusion. MethodsSeventy-two patients with acute atherosclerotic intracranial large vessel occlusion underwent endovascular treatment in our hospital from March 2018 to March 2019 were chosen in our study; ADAPT technique was used in 24 patients, and Solitaire stent combined with penumbra suction catheter extraction (Solumbra) technique was used in 48 patients. Remedial measures were adopted after the failure of recanalization. Modified intraoperative cerebral infarction thrombolysis grading was used for vascular recanalization evaluation. The prognoses of the patients were determined according to modified Rankin scale (mRS) scores 3 months after operation, and the efficacy and safety of the patients in the two groups were compared.ResultsAs compared with patients in the Solumbra group, patients in the ADAPT group had statistically shorter time from femoral artery puncture to reflow (P<0.05). The first-time recanalization rates of patients in Solumbra group and ADAPT group were 25.0％ and 16.67％, without statistically significant difference (P>0.05). The final recanalization rates of patients in Solumbra group and ADAPT group were 83.33％ and 75.00％, without statistically significant difference (P>0.05). There was no significant difference in proportion of patients with good prognosis, incidence of perioperative symptomatic intracranial hemorrhage and mortality between the two groups (P>0.05). ConclusionFor patients with acute atherosclerotic intracranial large vessel occlusion, endovascular treatment with ADAPT technique is comparable with Solumbra technique.

Application of retrievable Solitaire AB stents in the endovascular treatment of acute ischemic stroke.

Purpose: Retrievable stents are widely used in acute ischemic stroke (AIS); however, the results remain unclear in Chinese patients. This study aimed to explore the usefulness of Solitaire AB stents in AIS. Materials and Methods: Seventy-three AIS patients treated with Solitaire AB stents for thrombectomy of large artery occlusion of anterior circulation in January 2014-June 2015 were retrospectively evaluated. Recanalization was assessed with the Thrombolysis In Cerebral Ischemia (TICI) scale. Clinical outcomes were assessed according to the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Operation-related complications were recorded. The main factors affecting successful recanalization with Solitaire AB were analyzed. Results: The 73 patients enrolled included 39 males and 34 females (median age of 59 [31-78] years); 77 Solitaire AB stents were used. The initial recanalization rate with Solitaire AB as the first thrombectomy method was 53.42% (39/73; recanalization group). Among the 34 patients with failed stent retrieval, 32 underwent other treatments; the final arterial recanalization rate was 89.04% (65/73). Perioperative embolization events and symptomatic intracranial hemorrhage (sICH) occurred in 5 and 8 patients, respectively. The mean NIHSS score was 9.12±3.86 one week after thrombectomy, significantly lower compared with admission values. In 31 patients (42.47%), NIHSS score decreased by >8. Good functional independence (mRS score≤2) was achieved in 39 patients (53.42%) at 90 days; 12 patients (16.44%) died. Compared with the recanalization group, the remaining patients showed lower AF and higher LAA percentages. Conclusion: Solitaire AB stents are useful in the endovascular treatment of AIS.

How to Escape Stentriever Wedging in an Open-cell Carotid Stent during Mechanical Thrombectomy for Tandem Cervical Internal Carotid Artery and Middle Cerebral Artery Occlusion.

We present 2 cases of complicated mechanical thrombectomy involving tandem cervical internal carotid artery and middle cerebral artery occlusion using the Solitaire FR stent and simultaneous carotid stent angioplasty. During the procedures, the Solitaire stents containing the thrombus were wedged into the open-cell carotid stents, which were already deployed for proximal flow restoration. We describe the methods used to avoid and overcome such complications.

Solitaire Stent in the Treatment of Acute Ischemic Stroke with Large Cerebral Artery Occlusion.

OBJECTIVE: To investigate the effect of mechanical thrombectomy with solitaire stent in the treatment of acute ischemic stroke with large cerebral artery occlusion. METHODS: Fifteen acute ischemic stroke patients with a proximal intracranial occlusion in the anterior circulation were included within 6 hours after symptom onset (unknown time of onset allowed in wake upstroke). Patients with a large infarct core or poor collateral circulation on computed tomography (CT) and CT angiography were excluded. All patients were measured by the National Institutes of Health Stroke Scale (NIHSS) before and 24 hours after the procedure. The primary outcomes were reperfusion at 24 hours and a Thrombolysis in Cerebral Infarction (TICI) score of 2b or 3 indicates successful reperfusion. Secondary outcomes included the functional score on the Modified Rankin Scale(MRS) and NIHSS score at 90 days. Good Functional Outcome (GFO), is defined as mRS0-2 at 90 days. RESULTS: The preoperative TICI grading of these 15 patients were all level 0.14 patients were level 2b to level 3 after the thrombectomy, 1 ipsilateral cervical carotid occlusion patient failed recanalization.14 patients with reperfusion at 24 hours showed good early neurologic improvement. The MRS score of all the 14 patients were<2 point at 90 days. There were no obvious adverse reactions and complications in these patients after mechanical thrombectomy. CONCLUSION: The application of mechanical thrombectomy with solitaire stent for the treatment of acute ischemic stroke with large cerebral artery occlusion is safe and time-efficient, which could improve the recanalization rate, decrease or even eliminate the application of thrombolytic drugs and reduce the rate of intracranial hemorrhage. Awake stroke patient can also benefit from thrombectomy.

Carotid Endarterectomy to Remove Retained Solitaire Stent Retriever inside Carotid Stent after Mechanical Thrombectomy.

BACKGROUND: Tandem occlusions of the internal carotid artery (ICA) and middle cerebral artery (MCA) occur in up to a third of patients with acute ischemic strokes undergoing endovascular mechanical thrombectomy. Understanding open neurosurgical management of associated complications with this procedure is important. CASE REPORT: A 67-year-old man with acute onset of left hemiparesis and a tandem right ICA and MCA occlusion. He underwent carotid stent angioplasty of a stenotic ICA, followed by attempted Solitaire stent retrieval of an MCA clot. On withdrawal, the tines of the Solitaire stent lodged inside the Precise carotid stent. The patient was started on aspirin, Plavix, and heparin infusion, and underwent a carotid endarterectomy (CEA) with safe removal of the stents and primary vessel repair. CONCLUSION: This is the first case reported to date of a Solitaire stent becoming lodged inside a Precise carotid stent, salvaged by CEA with safe removal of the stents and primary vessel repair. We discuss the timing, indication, alternatives, and technical nuances of a CEA in this setting.

Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost.

BACKGROUND: Endovascular thrombectomy improves functional outcome in large vessel occlusion ischemic stroke. We examined disability, quality of life, survival and acute care costs in the EXTEND-IA trial, which used CT-perfusion imaging selection. METHODS: Large vessel ischemic stroke patients with favorable CT-perfusion were randomized to endovascular thrombectomy after alteplase versus alteplase-only. Clinical outcome was prospectively measured using 90-day modified Rankin scale (mRS). Individual patient expected survival and net difference in Disability/Quality-adjusted life years (DALY/QALY) up to 15 years from stroke were modeled using age, sex, 90-day mRS, and utility scores. Level of care within the first 90 days was prospectively measured and used to estimate procedure and inpatient care costs (US$ reference year 2014). RESULTS: There were 70 patients, 35 in each arm, mean age 69, median NIHSS 15 (IQR 12-19). The median (IQR) disability-weighted utility score at 90 days was 0.65 (0.00-0.91) in the alteplase-only versus 0.91 (0.65-1.00) in the endovascular group (p = 0.005). Modeled life expectancy was greater in the endovascular versus alteplase-only group (median 15.6 versus 11.2 years, p = 0.02). The endovascular thrombectomy group had fewer simulated DALYs lost over 15 years [median (IQR) 5.5 (3.2-8.7) versus 8.9 (4.7-13.8), p = 0.02] and more QALY gained [median (IQR) 9.3 (4.2-13.1) versus 4.9 (0.3-8.5), p = 0.03]. Endovascular patients spent less time in hospital [median (IQR) 5 (3-11) days versus 8 (5-14) days, p = 0.04] and rehabilitation [median (IQR) 0 (0-28) versus 27 (0-65) days, p = 0.03]. The estimated inpatient costs in the first 90 days were less in the thrombectomy group (average US$15,689 versus US$30,569, p = 0.008) offsetting the costs of interhospital transport and the thrombectomy procedure (average US$10,515). The average saving per patient treated with thrombectomy was US$4,365. CONCLUSION: Thrombectomy patients with large vessel occlusion and salvageable tissue on CT-perfusion had reduced length of stay and overall costs to 90 days. There was evidence of clinically relevant improvement in long-term survival and quality of life. CLINICAL TRIAL REGISTRATION: http://www.ClinicalTrials.gov NCT01492725 (registered 20/11/2011).

Combined use of a pCONus and a Solitaire stent: Report of two cases.

Objective The aim of this study was to report our initial experience of the use of the pCONus neck protection device in conjunction with the Solitaire AB stent to assist in the endovascular management of complex intracranial aneurysms with arteries arising from both the neck and the dome of the aneurysm. Methods Two patients with unruptured aneurysms underwent elective endovascular management of their aneurysms, one arising from the middle cerebral artery bifurcation and one from the anterior communicating artery. Both aneurysms had vessels arising from the neck and dome of the aneurysm. We present the strategy involved to protect all the arterial branches and coil occlude the aneurysm, the angiographic appearances and clinical status of the patients. Results Both cases involved the combined use of a pCONus and Solitaire stent. The parent vessel and efferent branches were all preserved with exclusion of the aneurysm from the circulation. There were no intraoperative complications. One patient developed mild transient symptoms 24 hours post procedure, which had resolved completely on discharge. Conclusion The use of the pCONus in conjunction with the Solitaire stent is a useful combination when dealing with complex wide-necked aneurysms with arteries derived from the fundus of the aneurysm.

How to Escape Stentriever Wedging in an Open-cell Carotid Stent during Mechanical Thrombectomy for Tandem Cervical Internal Carotid Artery and Middle Cerebral Artery Occlusion

We present 2 cases of complicated mechanical thrombectomy involving tandem cervical internal carotid artery and middle cerebral artery occlusion using the Solitaire FR stent and simultaneous carotid stent angioplasty. During the procedures, the Solitaire stents containing the thrombus were wedged into the open-cell carotid stents, which were already deployed for proximal flow restoration. We describe the methods used to avoid and overcome such complications.

Mechanical Solitaire Thrombectomy with Low-Dose Booster Tirofiban Injection.

PURPOSE: Mechanical thrombectomy using a Solitaire stent has been associated with a high recanalization rate and favorable clinical outcome in intra-arterial thrombolysis. To achieve a higher recanalization rate for mechanical Solitaire thrombectomy, we used an intra-arterial low-dose booster tirofiban injection into the occluded segment after stent deployment. We report the safety and recanalization rates for mechanical Solitaire thrombectomy with a low-dose booster tirofiban injection. MATERIALS AND METHODS: Between February and March 2013, 13 consecutive patients underwent mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. The occlusion sites included the proximal middle cerebral artery (5 patients), the internal carotid artery (5 patients), the top of the basilar artery (2 patients) and the distal middle cerebral artery (M2 segment, 1 patient). Six patients underwent bridge treatment, including intravenous tissue plasminogen activator. Tirofiban of 250 µg was used in all patients except one (500 µg). All occluded vessels were recanalized after 3 attempts at stent retrieval (1 time, n=9; 2 times, n=2; 3 times, n=2). RESULTS: Successful recanalization was achieved in all patients (TICI 3, n=8; TICI 2b, n=5). Procedural complications developed in 3 patients (subarachnoid hemorrhage, n=2; hemorrhagic transformation, n=1). Mortality occurred in one patient with a basilar artery occlusion due to reperfusion brain swelling after mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. Favorable clinical outcome (mRS≤2) was observed in 8 patients (61.5%). CONCLUSION: Our modified mechanical Solitaire thrombectomy method using a low-dose booster tirofiban injection might enhance the recanalization rate with no additive hemorrhagic complications.

Retrievable Stent-Assisted Coiling Technique Using a Solitaire Stent: Treatment of Pancreaticoduodenal Artery Aneurysm Associated With Celiac Artery Occlusion.

True aneurysm of pancreaticoduodenal arcade (PDA) is usually accompanied by stenosis or occlusion of celiac trunk (CeT). The up-to-date and first choice treatment modality of PDA aneurysm is the endovascular approach in nearly all cases except few selected ones necessitating surgery. The main approach in endovascular treatment is embolization of the aneurysm by preserving the parent artery. A case with concomitant CeT occlusion and PDA aneurysm was treated with coil embolization by preserving inferior pancreaticoduodenal artery with retrievable Solitaire(®) stent. In our knowledge, this is the first case with PDA aneurysm treated with this technique.

Mechanical thrombectomy by Solitaire stent for treating acute ischemic stroke: A prospective cohort study.

BACKGROUND: Acute ischemic stroke (AIS) is a worldwide serious health problem. Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the standard treatment; however, only a small number of patients benefit from it due to the strict application restrictions. Recently, more and more evidence prove mechanical thrombectomy is an effective and safe therapy of AIS. PATIENTS AND METHODS: From December 2010 to March 2015, 83 patients who underwent mechanical thrombectomy were collected as a sample pool. All patients met the following criteria: National Institutes of Health Stroke Scale (NIHSS) score ≥10, treatment performed within 6 h from the onset of symptoms, no large hypodensity on CT or multimodal MRI, and angiography revealed occlusion of a major cerebral artery. Recanalization rates were assessed immediately post-procedure by follow-up angiography according to the thrombolysis in cerebral infarction score criteria. Assessment of the modified Rankin Scale was performed 90 days after treatment. RESULTS: The mean age of patients was 63.3 years, and NIHSS scores 19.12 ± 4.60 at presentation. The vessel occlusions occurred in the middle cerebral artery (68.7%), distal internal carotid artery (7.2%), internal carotid artery with tandem middle cerebral artery occlusion (14.5%), basilar artery (2.4%), and vertebral artery (7.2%). Successful recanalization (TICI 3/2b) was achieved in 56 of 83 patients (67.5%). At 90-day follow-up, good clinical outcome (mRS ≤ 2) was achieved in 33 of 83 patients (39.8%), while 20 patients died (24.1%). CONCLUSIONS: This study revealed mechanical thrombectomy with Solitaire stent device was an effective and safe therapy, which achieved a high rate of angiographic recanalization and independent outcome accompanied by a low mortality rate.

[Primary mechanical thrombectomy for acute occlusions of cerebral arteries]. / Trombectomía mecánica primaria como tratamiento de la oclusión aguda de arterias intracerebrales.

EN: Cerebral ischemia due to occlusion of the principal intracranial arteries is a significant cause of morbidity and mortality. New devices for mechanical thrombectomy can facilitate rapid extraction of the thrombus. This paper describes the results of primary mechanical thrombectomy with the Solitaire revascularization device without intravenous fibrinolysis. From January 2010 to April 2013, 24 patients with occlusions of the main intracerebral arteries were treated by primary thrombectomy. The mean (SD) time elapsed from onset of symptoms until revascularization was 268 (11.3) minutes (range, 143-486 minutes). Revascularization was achieved in 19 patients (79.2%) within a punctureto- revascularization time of 63.9 (35.5) minutes. The mean score on the National Institute of Health Stroke Scale on admission was 21 (7.5) (range, 7-38). A score on the modified Rankin scale of 2 or lower was recorded for 15 patients (62.5%) on discharge and for 13 patients at 3 months. Three patients (12.5%) died from cerebral hemorrhage or infarct. It can be concluded that after ischemic stroke from occlusions of the main cerebral arteries, about 2 out of 3 of our patients benefited from primary mechanical extraction without intravenous fibrinolysis and had no or minimal disability on discharge.

ES: La isquemia cerebral por oclusión de las arterias principales intracraneales causa una importante morbimortalidad. Nuevos dispositivos para la trombectomía mecánica permiten la extracción del trombo en un tiempo reducido. Se muestran los resultados de la trombectomía mecánica primaria sin el uso de fibrinolisis intravenosa utilizando el dispositivo Solitaire. Desde enero de 2010 hasta abril de 2013, 24 pacientes presentaron una oclusión de vasos intracerebrales principales y fueron tratados mediante trombectomía primaria. El tiempo de inicio de síntomas hasta la recanalización fue de 268 (11,3) min (rango: 143-486 min). La recanalización se consiguió en 19 pacientes (79,2%), con un tiempo punción-revascularización de 63,9 (35,5) min. El NIHSS (National Institute of Health Stroke Scale) al ingreso fue de 21 (7,5) (7-38). Un mRS (modified Rankin scale) inferior o igual a 2 al alta se observó en 15 pacientes (62,5%) y en 13 a los 3 meses. Tres pacientes (12,5%) fallecieron por hemorragia cerebral o infarto. Se concluye que aproximadamente dos de cada tres pacientes se beneficiaron de la extracción mecánica primaria con ninguna o mínima discapacidad al alta, después de un ictus isquémico de vasos principales y sin utilizar la fibrinolisis intravenosa.

Mechanical Solitaire Thrombectomy with Low-Dose Booster Tirofiban Injection / 신경중재치료의학

PURPOSE: Mechanical thrombectomy using a Solitaire stent has been associated with a high recanalization rate and favorable clinical outcome in intra-arterial thrombolysis. To achieve a higher recanalization rate for mechanical Solitaire thrombectomy, we used an intra-arterial low-dose booster tirofiban injection into the occluded segment after stent deployment. We report the safety and recanalization rates for mechanical Solitaire thrombectomy with a low-dose booster tirofiban injection. MATERIALS AND METHODS: Between February and March 2013, 13 consecutive patients underwent mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. The occlusion sites included the proximal middle cerebral artery (5 patients), the internal carotid artery (5 patients), the top of the basilar artery (2 patients) and the distal middle cerebral artery (M2 segment, 1 patient). Six patients underwent bridge treatment, including intravenous tissue plasminogen activator. Tirofiban of 250 µg was used in all patients except one (500 µg). All occluded vessels were recanalized after 3 attempts at stent retrieval (1 time, n=9; 2 times, n=2; 3 times, n=2). RESULTS: Successful recanalization was achieved in all patients (TICI 3, n=8; TICI 2b, n=5). Procedural complications developed in 3 patients (subarachnoid hemorrhage, n=2; hemorrhagic transformation, n=1). Mortality occurred in one patient with a basilar artery occlusion due to reperfusion brain swelling after mechanical Solitaire thrombectomy with low-dose booster tirofiban injection. Favorable clinical outcome (mRS≤2) was observed in 8 patients (61.5%). CONCLUSION: Our modified mechanical Solitaire thrombectomy method using a low-dose booster tirofiban injection might enhance the recanalization rate with no additive hemorrhagic complications.