Introduction The Solitaire (Medtronic, Minneapolis, MN) is a stentriever device for endovascular treatment of acute ischemic stroke (AIS). The Solitaire is well described for use in temporary endovascular bypass, and mechanical thrombectomy. Permanent placement of the Solitaire is an option, but there are limited reports to date. The authors of this study review six cases of Solitaire stent implantation in the setting of large vessel occlusion and acute ischemic stroke, where temporary endovascular bypass and mechanical thrombectomy failed.

Materials and methods Six cases of failed mechanical thrombectomy are reviewed, including procedural review, timing of anti-platelet agents, and radiographic and clinical outcomes.

Results Six patients with severe, acute ischemic stroke (AIS) and large vessel occlusion (LVO) were triaged to mechanical thrombectomy. Despite multiple attempts at mechanical thrombus retrieval with a combination of devices including stentrievers and direct thrombus aspiration, flow could not be restored. As a bailout maneuver, the Solitaire stent was deployed and detached across the thrombus with TICI grade 3 flow restoration. All patients were loaded with full dose intra-arterial abciximab immediately after stent deployment and transitioned to dual antiplatelet therapy within 24 hours. There were no post-procedure hemorrhagic complications. All patients had significant neurological improvement post-procedurally, with favorable modified Rankin scores at follow-up.

Conclusion With the recent over-whelming evidence demonstrating the effectiveness endovascular therapy in acute ischemic stroke, the expansion of stroke therapy requires that a variety of techniques be available to the operators. Permanent implantation of the Solitaire stent achieves adequate distal flow and good clinical outcomes in the setting of AIS. This case series suggests this technique provides a safe alternative for difficult cases refractory to other revascularization techniques.

Key Words stroke, revascularization, stent

Disclosures J. Houde: None. E. Barber: None. M. Kelly: 2; C; Medtronic. 4; C; Blockade. 6; C; Penumbra. L. Peeling: None.