Solitaire FR as a first-line device in acute intracerebral occlusion: A single-centre retrospective analysis

doi:10.1016/j.neurad.2013.10.002

Journal of Neuroradiology

Volume 41, Issue 1, March 2014, Pages 80-86

https://doi.org/10.1016/j.neurad.2013.10.002 Get rights and content

Summary

Introduction

Analysing the clinical and angiographical effectiveness of the Solitaire FR as a mechanical thrombectomy device in acute intracerebral occlusion.

Methods

Sixty-two patients were retrospectively included between January 2010 and March 2012. All of them underwent mechanical thrombectomy with the Solitaire FR device with or without intravenous thrombolysis. Twenty-five patients had an occlusion of the basilar artery, 1 had a posterior cerebral artery occlusion. There were 16 M1 middle cerebral artery occlusions, 9 carotid T occlusions and 11 tandem occlusions. Clinical status was evaluated using the National Institute of Health Stroke Scale (NIHSS) before and 24 hours after treatment and at discharge. The Modified Rankin Scale (mRS) was evaluated at 3 months.

Results

Mean age of patients was 64.8 years. Mean NIHSS score on admission was 19.8. Stand-alone thrombectomy was used in 47 patients (75.8%). Recanalization was successful (TICI score 2b or 3) in 23 of 26 (88.5%) patients with posterior circulation occlusion and in 23 of 36 (63.9%) patients with anterior circulation occlusion. NIHSS improved by more than 10 points for 15 of 59 patients with initial NIHSS over 10. MRS was 0-2 in 25 of 62 patients (40.3%). Overall, 23 patients out of 62 died (37%). No complications related to the Solitaire device occurred.

Conclusion

These results confirm that the Solitaire FR device is safe and effective in stand-alone thrombectomy.

Introduction

Since the 1990s, the use of intravenous (IV) recombinant human tissue plasminogen factor has changed stroke prognosis, but the recanalization rate was still less than 50% [1], [2], [3], [4]. Several devices with different mechanisms of action were produced and designed to achieve mechanical thrombectomy when IV fibrinolysis was not suitable [5], [6], [7], [8]. Solitaire FR (ev3, Irvine CA, United States) was the first stent retriever to be described and used. It seems to allow faster and more effective procedures [9] but it is still very often used as a second-line device when IV fibrinolysis has failed or when the time windows for IV fibrinolysis has been passed. Several single-centre, retrospective studies have been published over the past few years [10], [11], [12], [13], [14], but almost all of them mainly included patients who had experienced IV fibrinolysis failure. In the present study, all of the patients were treated with a Solitaire thrombectomy device. The main objective of this study was to evaluate the effectiveness of the Solitaire FR especially when used as the only therapy in patients with acute intracerebral occlusion.

Section snippets

Methods

Consecutive patients who underwent mechanical thrombectomy were retrospectively analysed in this study. All of them arrived at the hospital within 6 hours after the onset of stroke involving the anterior circulation. The time window was extended to 24 hours for posterior circulation occlusion only if MRI ruled out any extensive brainstem lesion. Each patient was assessed by the on-call senior neurologist and an NIHSS score was ascertained on admission, at discharge and 90 days after treatment.

Patients’ data

Between January 2010 and March 2012, 66 patients with proximal occlusion in an intracranial vessel were eligible for mechanical thrombectomy in our institution. Four were excluded from the present study, one due to an ASPECT CBV score of 5, one had not undergone thrombectomy because of major problems with catheterization, and two for lack of data.

Sixty-two patients were retrospectively included and analysed in the present study. The mean age was 64.9 years old (SD = 17.1). The youngest was 16

Discussion

The Modified Rankin score at 3 months was lower than or equal to 2 in 40.3% of our patients even though revascularization was unsuccessful in 16 patients. These results are similar to those in other studies [10], [11], [12], [13], [16], [17], [18], [19], which reported 33 to 50% of patients with a good clinical outcome at 3 months (mRS 0-2). However, unlike patients in these studies, most of our patients (75.8%) did not have IV fibrinolysis.

The present study aimed to reflect the use of

Conclusion

Mechanical thrombectomy appears to be a safe and effective first-line therapy in patients with proximal occlusion after appropriate imaging screening. Randomised controlled trials are still needed to confirm these preliminary results.

Disclosure of interest

F.R. is an ev3 consultant. All the others have nothing to disclose.

Acknowledgments

Mr Philip Bastable from the medical English department. Mrs Lysiane Jonval from the clinical research department. Mr Ludwig Aho from the epidemiology department.

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The Safety and Efficacy of Mechanical Thrombectomy in Posterior VS. Anterior Emergent Large Vessel Occlusion: A Systematic Review and Meta-analysis
2020, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
3130 studies were subsequently excluded after screening the titles and abstracts because 2213 of them were irrelevant studies or animal experiments, and the remaining 917 studies were letters, reviews, and meeting abstracts. 186 studies were eligible for full-text review, and finally, 11 studies contained available data and were inclusive in our meta-analysis.25-35 All studies were published between 2011 and 2019, and the NOS scores ranged from 6 to 8, which suggested a moderate and high quality of all included studies (Supplemental Table 1).
Background and Purpose: Currently, mechanical thrombectomy (MT) for emergent large-vessel occlusion (ELVO) has been widely used in the clinic. However, the question about whether MT provides the same benefits between posterior circulation emergent large vessel occlusion (pc-ELVO) and anterior emergent large vessel occlusion (ac-ELVO) remains unclear. Material and Methods: We conducted a systematic review and meta-analysis of 11 studies published between 2011 and 2019 through searching the PubMed, EMBASE, and Cochrane Library. Major clinical outcomes include: (1) favorable functional outcome at 90 days; (2) symptomatic intracerebral hemorrhage (sICH); (3) mortality and; (4) successful recanalization rate. Results: Eleven of 4637 studies met our pre-established inclusion criterion, comprising 4619 patients. In primary analysis, MT in patients with pc-ELVO in comparison to patients with ac-ELVO had a lower likelihood of sICH (odds ratio [OR] = .48; [95% confidence interval (CI), .26-.88]; P = .02) but a higher likelihood of mortality (OR = 1.98; [95% CI, 1.37-2.87]; P = .0003). The pooled evidence indicated that patients with pc-ELVO had worse functional outcome than patients with ac-ELVO in the large sample size group (OR = .79; [95% CI, .63-.98]; P = .03). In addition, no statistical significance was found in the outcome of successful recanalization rate (OR = 1.12; [95% CI, .88-1.42]; P = .35). Conclusions: Our results showed that patients with pc-ELVO receiving MT reduced the risk of sICH but seemed to be associated with poor prognosis.
Effect of Baseline Characteristics on the Outcome of Stent Retriever–Based Thrombectomy in Acute Basilar Artery Occlusions: A Single-Center Experience and Pooled Data Analysis
2017, World Neurosurgery
Citation Excerpt :
The median quality score of the included studies was 3 (range, 1–6). Data from 5 studies were prospectively collected14-18 and 10 were retrospective.5,7-9,19-24 Six studies excluded patients with extensive brain stem infarction observed on diffusion-weighted imaging or computed tomography images.
To explore the association of baseline characteristics and the outcome of patients with acute basilar artery occlusion (BAO) after stent retriever–based thrombectomy (SRT).
Clinical and imaging information of consecutive SRT-treated patients with BAO from a comprehensive stroke center and up-to-date literature were reviewed respectively. The impact of baseline variables toward favorable outcome was evaluated using subgroup analysis and odds ratio (OR) extracted from published data together with single-center records using pooled analysis.
Nineteen cases from our center and 15 published studies involving 487 cases were included. Estimated pooled favorable outcome rate was 0.3746 (95% confidence interval [CI], 0.3165–0.4327), mortality was 0.2950 (95% CI, 0.2390–0.3510). Pooled estimates showed that successful reperfusion (modified thrombolysis in cerebral ischemia scale 2b or 3) gained by SRT alone was 0.7317 (95% CI, 0.6532–0.8102) and final successful reperfusion rate with or without additional reperfusion procedures was 0.8834 (95% CI, 0.8279–0.9390). Univariate analysis indicated that patients with successful reperfusion (OR, 2.05; P = 0.05), distal segment occlusion (OR, 2.03; P = 0.03), and cardioembolus origin (OR, 2.13; P = 0.01) were more likely to have favorable outcome (modified Rankin Scale score ≤2 at 3 months). Study series that applied intra-arterial thrombolysis, angioplasty, or stenting as rescuing therapy had higher successful reperfusion rate but they did not show a higher rate of favorable outcome.
SRT with or without additional treatment appeared to be effective for the treatment of BAO. Successful reperfusion, distal segment occlusion, and cardiac embolism were associated with favorable outcome. The overall benefit of lesions requiring additional reperfusion therapy was unclear.
Mechanical thrombectomy with the Solitaire AB stent for treatment of acute basilar artery occlusion: A single-center experience
2016, Journal of Clinical Neuroscience
Citation Excerpt :
Hence, the safety and efficacy of stent retriever MT remain unclear in patients with ischemic stroke caused by acute BAO. The aim of the present study was to evaluate the feasibility, efficacy, and safety of mechanical thrombectomy with the Solitaire AB stent, a type of self-expanding and fully retrievable stent, as a first-line endovascular therapy in patients with acute BAO [13,14]. The Solitaire AB stent was originally used for the treatment of intracranial aneurysms, and has the same structure as the Solitaire FR (Covidien), a classic stent retriever for MT.
Basilar artery occlusion (BAO) remains one of the most devastating subtypes of ischemic stroke, and prognosis is poor if early recanalization is not achieved. The purpose of this study was to evaluate the safety and technical feasibility of mechanical thrombectomy with the Solitaire AB stent (Covidien, Irvine, CA, USA) for the treatment of acute BAO through a single-center experience. Twenty-one patients with acute BAO were treated with mechanical thrombectomy with the Solitaire AB stent device between 1st September 2011 and 1st December 2014. Recanalization was assessed using the Thrombolysis in Cerebral Infarction (TICI) scale system. Clinical outcome was established at discharge by The National Institute of Health Stroke Scale (NIHSS), and the mean time from symptom onset to recanalization determined. Authors had access to identifying information during or after data collection. The clinical status of patients on admission was severe, with a mean NIHSS score of 25.57 ± 5.20 (range: 16–38), and the number of patients with TICI 2b or 3 was 0. The mean time from symptom onset to recanalization was 579.00 ± 188.78 min (range: 360–960 min). At 3-month follow-up, eight (38.1%) patients had a good clinical outcome. At follow-up, the trial of ORG 10172 in acute stroke treatment (TOAST) classification was large-vessel atherosclerosis in 13 patients (61.9%), cardioembolic in seven patients (33.3%), and undetermined in one patient (4.8%). In our series, application of the Solitaire AB stent retriever in acute BAO resulted in a high recanalization rate without procedural complications, and with good clinical outcome. Further prospective trials are needed to confirm the potential clinical benefit of this treatment approach.
Neuroradiology of acute stroke, where are we today?
2015, Journal of Neuroradiology
Mechanical thrombectomy in anterior vs. posterior circulation stroke: A systematic review and meta-analysis
2022, Interventional Neuroradiology
Comparison of Risk Factors, Safety, and Efficacy Outcomes of Mechanical Thrombectomy in Posterior vs. Anterior Circulation Large Vessel Occlusion
2021, Frontiers in Neurology

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View full text

Original articleSolitaire FR as a first-line device in acute intracerebral occlusion: A single-centre retrospective analysis

Summary

Introduction

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Patients’ data

Discussion

Conclusion

Disclosure of interest

Acknowledgments

Lancet

J Neuroradiol J Neuroradiol

Eur J Radiol

Lancet

Lancet

Effects of tissue plasminogen activator for acute ischemic stroke at one year

N Engl J Med

The impact of recanalization on ischemic stroke outcome: a meta-analysis

Stroke J Cereb Circ

Tissue plasminogen activator for acute ischemic stroke

N Engl J Med

MERCI 1: a phase 1 study of mechanical embolus removal in cerebral ischemia

Stroke J Cereb Circ

Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial

Stroke J Cereb Circ

The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease

Stroke J Cereb Circ

The POST trial: initial post-market experience of the Penumbra system: revascularization of large vessel occlusion in acute ischemic stroke in the United States and Europe

J Neurointerventional Surg

Impact of retrievable stents on acute ischemic stroke treatment

AJNR Am J Neuroradiol

Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions

Stroke J Cereb Circ

Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study

Stroke J Cereb Circ

Rescue, combined, and stand-alone thrombectomy in the management of large vessel occlusion stroke using the solitaire device: a prospective 50-patient single-center study: timing, safety, and efficacy

Stroke J Cereb Circ

Mechanical thrombectomy with a self-expanding retrievable intracranial stent (Solitaire AB): experience in 26 patients with acute cerebral artery occlusion

AJNR Am J Neuroradiol

Treatment of acute middle cerebral artery occlusion with a Solitaire AB stent: preliminary experience

Br J Radiol

Original article
Solitaire FR as a first-line device in acute intracerebral occlusion: A single-centre retrospective analysis