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Original research
Double stent-retriever as the first-line approach in mechanical thrombectomy: a randomized in vitro evaluation
  1. Jiahui Li1,
  2. Riccardo Tiberi1,
  3. Pere Canals1,
  4. Daniel Vargas2,
  5. Oscar Castaño3,4,
  6. Marc Molina1,
  7. Alejandro Tomasello2,
  8. Marc Ribo1
  1. 1Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Spain
  2. 2Department of Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
  3. 3Electronics and Biomedical Engineering, University of Barcelona, Barcelona, Spain
  4. 4Biomaterials for Regenerative Therapies, Institute for Bioengineering in Catalonia, Barcelona, Spain
  1. Correspondence to Dr Marc Ribo, Stroke Unit, Vall d'Hebron University Hospital, Barcelona, 119-129, Spain; marcriboj{at}hotmail.com

Abstract

Background A repeated number of passes during mechanical thrombectomy leads to worse clinical outcomes in acute ischemic stroke. Initial experiences with the simultaneous double stent-retriever (double-SR) technique as the first-line treatment showed promising safety and efficacy results.

Objective To characterize the potential benefits of using the double-SR as first-line technique as compared with the traditional single-SR approach.

Methods Three types of clot analogs (soft, moderately stiff, and stiff) were used to create terminal internal carotid artery (T-ICA=44) and middle cerebral artery (MCA=88) occlusions in an in vitro neurovascular model. Sixty-six cases were randomized into each treatment arm: single-SR or double-SR, in combination with a 0.071" distal aspiration catheter. A total of 132 in vitro thrombectomies were performed. Primary endpoints were the rate of first-pass recanalization (%FPR) and procedural-related distal emboli.

Results FPR was achieved in 42% of the cases. Overall, double-SR achieved a significantly higher %FPR than single-SR (52% vs 33%, P=0.035). Both techniques showed similar %FPR in T-ICA occlusions (single vs double: 23% vs 27%, P=0.728). Double-SR significantly outperformed single-SR in MCA occlusions (63% vs 38%, P=0.019), most notably in saddle occlusions (64% vs 14%, P=0.011), although no significant differences were found in single-branch occlusions (64% vs 50%, P=0.275). Double-SR reduced the maximal size of the clot fragments migrating distally (Feret diameter=1.08±0.65 mm vs 2.05±1.14 mm, P=0.038).

Conclusions This randomized in vitro evaluation demonstrates that the front-line double-SR technique is more effective than single-SR in achieving FPR when treating MCA bifurcation occlusions that present saddle thrombus.

  • Stroke
  • Technique
  • Thrombectomy

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Data relevant to the study are included in the article. All data are available upon reasonable request to the corresponding author.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Data relevant to the study are included in the article. All data are available upon reasonable request to the corresponding author.

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Footnotes

  • Twitter @marcriboj

  • Contributors Conception and design: MR, JL, RT, and AT. Data acquisition: JL, RT, PC, and MM. Data analysis and interpretation: JL and MR. Drafting the manuscript: JL and MR. Technical/material support: DV and AT. Critically revising the article: MR, OC and AT. Reviewed submitted version of the manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MR received research funding from Medtronic and Balt; declares ownership of Anaconda Biomed, and Methinks shares; received consulting fees from Anaconda Biomed, Apta Targets, Medtronic, Stryker, Cerenovus, and Philips. AT reports receiving consulting fees from Anaconda Biomed, Balt, Medtronic, Perflow, and Stryker. The other authors have no conflicts of interest to declare that are relevant to the content of this article.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.