Abstract
Introduction
The purpose of this study was to evaluate the safety and efficacy of the pREset stent retriever in a real-world clinical setting.
Methods
Patients treated with pREset were selected from a prospectively maintained single-center database. A TICI score ≥2b after ≤3 passes was regarded as successful recanalization. All device-related complications and their clinical significance were reported. Parenchymal hematomas (PH) were classified according to ECASS, adding focal and diffuse subarachnoid hemorrhage (SAH) as categories. A 90-day mRS of 0–2 was defined as favorable outcome. In addition, we separately analyzed patients treated with >3 pREset passes and patients receiving other rescue maneuvers.
Results
We included 271 patients. Successful recanalization was achieved in 76.4 %. Device-related complications occurred in 9.2 % of which 2.2 % were clinically significant. PH I, PH II, focal SAH, and diffuse SAH was observed in 5.2, 4.8, 12.2, and 2.2 %, respectively. A total of 39.5 % of patients had favorable clinical outcome. Considering treatments with >3 pREset passes or other rescue procedures, an additional 8.5 and 9.3 % of target vessels were recanalized. The chance of favorable clinical outcome decreased significantly with any kind of rescue therapy. In addition, the rate of PH I was significantly higher in patients treated with >3 pREset passes, whereas all other types of hemorrhage showed no difference.
Conclusion
In terms of safety and effectiveness, pREset performed comparably to other stent retriever devices. To avoid futile recanalization and potential additional harm, escalation of therapy beyond three thrombectomy passes should only be performed after careful individual consideration of each case.
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References
Broderick J, Palesch Y, Demchuk M et al (2013) Endovascular therapy after intravenous t-PTA versus t-PA alone for stroke. N Engl J Med 368:893–903
Ciccone A, Valvassori L, Nichelatti M et al (2013) Endovascular treatment for acute ischemic stroke. N Engl J Med 368:904–913
Kidwell C, Jahan R, Gornbein J et al (2013) A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 368:914–923
Pierot L, Södermann M, Bendszus M et al (2013) Statement of ESMINT and ESNR regarding recent trials evaluating the endovascular treatment at the acute stage of ischemic stroke. Neuroradiology 55:1313–1318
Saver J, Jahan R, Levy E et al (2012) Solitaire flow restoration device versus the MERCI retriever in patient with acute ischemic stroke (SWIFT): a randomized, parallel-group, non-inferiority trial. Lancet 380:1241–1249
Nogueira RG, Lutsep HL, Gupta R et al (2012) Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 380:1231–1240
Kranz P, Eastwood J (2009) Does diffusion-weighted imaging represent the ischemic core? An evidence-bases systematic review. Am J Neuroradiol 30:1206–1212
Tomsick T, Broderick J, Carrozella J (2008) et a. (2008) Interventional Management of Stroke II investigators. Revascularization results in the Interventional Management of Stroke II trial. Am J Neuroradiol 29:582–587
Hacke W, Kaste M, Fieschi C et al (1998) Randomized double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischemic stroke (ECASSII). Lancet 352:1245–1251
Mordasini P, Brekenfeld C, Byrne J et al (2012) Experimental evaluation of immediate recanalization effect and recanalization efficacy of a new thrombus retriever for acute stroke treatment in vivo. Am J Neuroradiol. doi:10.3174/ajnr.A3275
Pereira V, Gralla J, Davalos A et al (2013) Prospective, multicenter, single-arm study of mechanical thrombectomy using Solitaire flow restoration in acute ischemic stroke. Stroke 44:2802–2807
Mazigi M, Chaudry S, Ribo M et al (2013) Impact of onset-to-reperfusion time on stroke mortality. Circulation 127:1980–1985
Walcott B, Boehm K, Stapleton C et al (2013) Retrievable stent thrombectomy in the treatment of acute ischemic stroke: analysis of a revolutionizing treatment technique. J Clin Neurosci. doi:10.1016/j.jocn.2013.03.015
Davalos A, Mendes Pereira V, Chapot R et al (2012) Retrospective multicenter study of Solitaire FR for revascularization in the treatment of acute ischemic stroke. Stroke 43:2699–2705
Zaidat O, Castonguay A, Gupta R et al. (2013) North American Solitaire stent retriever acute stroke registry: post marketing revascularization and clinical outcome results. J Neurointervent Surg 0:1-5 doi: 10.1136/neurointersurg-2013-010895
Singer O, Haring H, Trenkler J (2013) Age-dependency of successful recanalization in anterior circulation stroke: the ENDOSTROKE study. Cerebrovasc Dis 365:437–445
Acknowledgements
We thank James Lago for language revision of the manuscript and Hiltrud Niggemann for statistical support.
Conflict of interest
WK has a consulting agreement with phenox. MA-P has proctoring contracts with Covidien/ev3 and phenox. HH is co-inventor of Solitaire, has consulting and proctoring contracts with Codman, Covidien/ev3 and Balt and is co-founder and shareholder of phenox.
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Kurre, W., Aguilar-Pérez, M., Schmid, E. et al. Clinical experience with the pREset stent retriever for the treatment of acute ischemic stroke—a review of 271 consecutive cases. Neuroradiology 56, 397–403 (2014). https://doi.org/10.1007/s00234-014-1346-y
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DOI: https://doi.org/10.1007/s00234-014-1346-y