Background The use of retrievable stents for endovascular clot retrieval has dramatically improved successful revascularization and clinical outcome in selected patients with acute stroke.
Objective To describe the rate and clinical consequences of unwanted spontaneous detachment of these devices during mechanical thrombectomy.
Methods We studied 262 consecutive patients treated with the retrievable stent, Solitaire, for acute ischemic stroke between November 2008 and April 2015. Clinical, procedural, and outcome variables were compared between patients with and without unexpected detachment of this device. Detachment was classified as proximal to the stent proximal marker (type A) or distal to the marker (type B). Poor functional outcome was defined as modified Rankin scale score >2 at 90 days.
Results Unwanted detachment occurred in 6/262 (2.3%) cases, four of type A and two of type B. Stent recovery was possible in three patients, all of ‘type A’, but in none of ‘type B’. The number of prior passes was higher in patients with undesired detachment (3 (2–5) vs 2 (1–3), p=0.007). Detachment was associated with higher rate of symptomatic intracranial hemorrhage (SICH) (33.3% vs 4.3%, p=0.001), poorer outcome (100% vs 54.8%, p=0.028), and higher mortality rate at 90 days (50% vs 17%, p=0.038).
Conclusions Unwanted detachment of a Solitaire is an uncommon complication during mechanical thrombectomy in patients with acute ischemic stroke and is associated with the clot retrieval attempts, SICH, poor outcome, and higher mortality.
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Contributors CCa: conception and design; analysis and interpretation of data; drafting of the article; participated in the direct treatment of patients in the study. LD: acquisition of data; analysis and interpretation of data; revision of the article critically for important intellectual content. SR, PG-B, MRG-S, CH, CCu: acquisition of data; revision of the article critically for important intellectual content; participated in the direct treatment of patients in the study. MG, NPdlO, MM, EL-C: acquisition of data; revision of the article critically for important intellectual content. AD: analysis and interpretation of data; drafting the article and revising it critically for important intellectual content. All authors gave final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Competing interests CC is Covidien consultant; AD is Co PI of REVASCAT trial; other authors report no conflict of interest. All the coauthors have reviewed and approved the final version of the manuscript. All coauthors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Provenance and peer review Not commissioned; externally peer reviewed.
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