Article Text

other Versions

PDF
Original research
Stentrievers versus other endovascular treatment methods for acute stroke: comparison of procedural results and their relationship to outcomes
  1. Marc Ribo1,
  2. Carlos A Molina1,
  3. Brian Jankowitz2,
  4. Alejandro Tomasello3,
  5. Syed Zaidi4,
  6. Mouhammad Jumaa4,
  7. Pilar Coscojuela3,
  8. Jennifer Oakley4,
  9. José Alvarez-Sabín1,
  10. Tudor Jovin4
  1. 1Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
  2. 2Department of Neurosurgery, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  3. 3Department of Radiology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
  4. 4Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Marc Ribo, Stroke Unit, Department of Neurology, Unitat d'Ictus, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, Barcelona 08035, Spain; marcriboj{at}hotmail.com

Abstract

Background and purpose The use of stentrievers (ST) is rapidly growing due to several potential benefits over other available treatments. ST potentially restore flow before clot retrieval and reduce procedural time. We aimed to study the impact of these potential benefits.

Methods Patients with acute stroke treated with endovascular procedures in two stroke centers were studied. According to device availability, patients were treated either with intra-arterial tissue plasminogen activator (IAT), Merci or ST. We defined time to initial flow restoration as time from symptom onset to first pass of contrast to previously occluded arteries either through the deployed device or after recanalization. Complete recanalization (Thrombolysis In Cerebral Infarction >2b), day 5 National Institute of Health Stroke Scale (NIHSS) score and favorable outcome at 3 months (modified Rankin Scale score≤2) were recorded.

Results A total of 315 patients were studied: 127 IAT, 119 Merci, 69 ST (26 Trevo, 43 Solitaire). No major differences were observed in baseline characteristics between the treatment groups. The rate of complete recanalization was higher with ST (67.2%) than with IAT (50.8%) or Merci (57.3%) (p=0.05). Time from groin puncture to final recanalization was lower with ST (88±46 min) than with IAT (103±70 min) or Merci (128±62 min) (p<0.01) and time from groin puncture to initial flow restoration was shorter with ST (36±18 min) than with IAT (92±67 min) or Merci (114±57 min) (p<0.01). Discharge NIHSS was lower in the ST group (7, IQR 1–26) than in the IAT (14, 2–30) or Merci (12, 5–30) groups (p=0.05) and the rate of favorable outcome was higher: ST (52.9%) vs IAT (33.9%) and Merci (40%) (p=0.03). The use of a ST increased the odds of a favorable outcome (OR 1.9, 95% CI 1.04 to 3.39; p=0.037).

Conclusions In acute endovascular treatment of stroke, the use of ST may increase recanalization and reduce time to flow restoration leading to improved outcomes.

  • Angiography
  • Blood Flow
  • Stroke
  • Stent
  • Thrombectomy

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.