Skip to main content

Advertisement

Log in

A retrieval thrombectomy technique with the Solitaire stent in a large cerebral artery occlusion

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

To describe preliminary experiences and the procedural details of retrieval thrombectomy using a self-expanding and fully retrievable Solitaire stent (ev 3 Inc., CA, USA) in acute ischemic stroke (AIS) patients with large artery occlusions.

Methods

Eight patients with AIS were treated by mechanical thrombectomy using a self-expanding, fully retrievable stent (Solitaire, ev 3 Inc., CA, USA). The stent was deployed to cover the whole intra-arterial clot and then it was slowly retrieved while occluding the internal cerebral artery (ICA) with a balloon guiding catheter. Additionally, continuous negative pressure was applied through the balloon guiding catheter with a specially designed gun device. Occlusion sites were M1 in six cases including one combined supraclinoid ICA occlusion and the other combined M2 occlusion, M2 in 1 case and one basilar artery top.

Results

Complete recanalization was achieved in all patients. Procedure time was 45 min or less in seven cases and 70 min in one case. Distal emboli occurred in one case in which the balloon guide catheter was not used. Only in this case was intraarterial fibrinolytics infusion necessary. There was no post-operative intracranial hemorrhage.

Conclusions

In our experience, retrieval thrombectomy with the Solitaire stent was a simple and effective method for reopening large cerebral arteries in AIS patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. (1995) Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 333:1581–1587

  2. Castano C, Dorado L, Guerrero C, Millan M, Gomis M, Perez de la Ossa N, Castellanos M, Garcia MR, Domenech S, Davalos A (2010) Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke 41:1836–1840

    Article  PubMed  Google Scholar 

  3. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282:2003–2011

    Article  PubMed  CAS  Google Scholar 

  4. Henkes H, Flesser A, Brew S, Miloslavski E, Doerfler A, Felber S, Monstadt H, Kuehne D (2003) A novel microcatheter-delivered, highly-flexible and fully-retrievable stent, specifically designed for intracranial use. Technical note. Interv Neuroradiol 9:391–393

    PubMed  CAS  Google Scholar 

  5. Jansen O, Schellinger P, Fiebach J, Hacke W, Sartor K (1999) Early recanalisation in acute ischaemic stroke saves tissue at risk defined by MRI. Lancet 353:2036–2037

    Article  PubMed  CAS  Google Scholar 

  6. Khatri P, Abruzzo T, Yeatts SD, Nichols C, Broderick JP, Tomsick TA (2009) Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology 73:1066–1072

    Article  PubMed  CAS  Google Scholar 

  7. Khatri P, Wechsler LR, Broderick JP (2007) Intracranial hemorrhage associated with revascularization therapies. Stroke 38:431–440

    Article  PubMed  Google Scholar 

  8. Mpotsaris A, Bussmeyer M, Loehr C, Oelerich M, Buchner H, Weber W (2011) Mechanical thrombectomy in severe acute stroke: preliminary results of the Solitaire stent. J Neurol Neurosurg Psychiatry (in press)

  9. Nogueira RG, Schwamm LH, Buonanno FS, Koroshetz WJ, Yoo AJ, Rabinov JD, Pryor JC, Hirsch JA (2008) Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions. Neuroradiology 50:331–340

    Article  PubMed  Google Scholar 

  10. Patel SC, Mody A (1999) Cerebral hemorrhagic complications of thrombolytic therapy. Prog Cardiovasc Dis 42:217–233

    Article  PubMed  CAS  Google Scholar 

  11. Rha JH, Saver JL (2007) The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 38:967–973

    Article  PubMed  Google Scholar 

  12. Roth C, Papanagiotou P, Behnke S, Walter S, Haass A, Becker C, Fassbender K, Politi M, Korner H, Romann MS, Reith W (2010) Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke 41:2559–2567

    Article  PubMed  CAS  Google Scholar 

  13. Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, Lutsep HL, Rymer MM, Higashida RT, Starkman S, Gobin YP, Frei D, Grobelny T, Hellinger F, Huddle D, Kidwell C, Koroshetz W, Marks M, Nesbit G, Silverman IE (2008) Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39:1205–1212

    Article  PubMed  Google Scholar 

  14. Vora NA, Gupta R, Thomas AJ, Horowitz MB, Tayal AH, Hammer MD, Uchino K, Wechsler LR, Jovin TG (2007) Factors predicting hemorrhagic complications after multimodal reperfusion therapy for acute ischemic stroke. AJNR Am J Neuroradiol 28:1391–1394

    Article  PubMed  CAS  Google Scholar 

  15. Yokogami K, Nakano S, Ohta H, Goya T, Wakisaka S (1996) Prediction of hemorrhagic complications after thrombolytic therapy for middle cerebral artery occlusion: value of pre- and post-therapeutic computed tomographic findings and angiographic occlusive site. Neurosurgery 39:1102–1107

    Article  PubMed  CAS  Google Scholar 

  16. Yoneyama T, Nakano S, Kawano H, Iseda T, Ikeda T, Goya T, Wakisaka S (2002) Combined direct percutaneous transluminal angioplasty and low-dose native tissue plasminogen activator therapy for acute embolic middle cerebral artery trunk occlusion. AJNR Am J Neuroradiol 23:277–281

    PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to O-Ki Kwon.

Additional information

This study was supported by grant no. 02-2010-021 from the SNUBH Research Fund.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Park, H., Hwang, G.j., Jin, SC. et al. A retrieval thrombectomy technique with the Solitaire stent in a large cerebral artery occlusion. Acta Neurochir 153, 1625–1631 (2011). https://doi.org/10.1007/s00701-011-0999-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-011-0999-0

Keywords

Navigation