C Castaño1, L Dorado2, S Remollo1, P García-Bermejo3, M Gomis2, N Pérez de la Ossa2, M Millán2, M R García-Sort1, C Hidalgo1, E López-Cancio2, C Cubells4, A Dávalos2. 1. Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain. 2. Acute Stroke Unit, Service of Neurology, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain. 3. Departament of Neurology, Hamad General Hospital. Academic Health System, Doha, Qatar. 4. Department of Anesthesiology, Hospital Universitari Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona (Barcelona), Spain.
Abstract
BACKGROUND: The use of retrievable stents for endovascular clot retrieval has dramatically improved successful revascularization and clinical outcome in selected patients with acute stroke. OBJECTIVE: To describe the rate and clinical consequences of unwanted spontaneous detachment of these devices during mechanical thrombectomy. METHODS: We studied 262 consecutive patients treated with the retrievable stent, Solitaire, for acute ischemic stroke between November 2008 and April 2015. Clinical, procedural, and outcome variables were compared between patients with and without unexpected detachment of this device. Detachment was classified as proximal to the stent proximal marker (type A) or distal to the marker (type B). Poor functional outcome was defined as modified Rankin scale score >2 at 90 days. RESULTS: Unwanted detachment occurred in 6/262 (2.3%) cases, four of type A and two of type B. Stent recovery was possible in three patients, all of 'type A', but in none of 'type B'. The number of prior passes was higher in patients with undesired detachment (3 (2-5) vs 2 (1-3), p=0.007). Detachment was associated with higher rate of symptomatic intracranial hemorrhage (SICH) (33.3% vs 4.3%, p=0.001), poorer outcome (100% vs 54.8%, p=0.028), and higher mortality rate at 90 days (50% vs 17%, p=0.038). CONCLUSIONS: Unwanted detachment of a Solitaire is an uncommon complication during mechanical thrombectomy in patients with acute ischemic stroke and is associated with the clot retrieval attempts, SICH, poor outcome, and higher mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
BACKGROUND: The use of retrievable stents for endovascular clot retrieval has dramatically improved successful revascularization and clinical outcome in selected patients with acute stroke. OBJECTIVE: To describe the rate and clinical consequences of unwanted spontaneous detachment of these devices during mechanical thrombectomy. METHODS: We studied 262 consecutive patients treated with the retrievable stent, Solitaire, for acute ischemic stroke between November 2008 and April 2015. Clinical, procedural, and outcome variables were compared between patients with and without unexpected detachment of this device. Detachment was classified as proximal to the stent proximal marker (type A) or distal to the marker (type B). Poor functional outcome was defined as modified Rankin scale score >2 at 90 days. RESULTS: Unwanted detachment occurred in 6/262 (2.3%) cases, four of type A and two of type B. Stent recovery was possible in three patients, all of 'type A', but in none of 'type B'. The number of prior passes was higher in patients with undesired detachment (3 (2-5) vs 2 (1-3), p=0.007). Detachment was associated with higher rate of symptomatic intracranial hemorrhage (SICH) (33.3% vs 4.3%, p=0.001), poorer outcome (100% vs 54.8%, p=0.028), and higher mortality rate at 90 days (50% vs 17%, p=0.038). CONCLUSIONS: Unwanted detachment of a Solitaire is an uncommon complication during mechanical thrombectomy in patients with acute ischemic stroke and is associated with the clot retrieval attempts, SICH, poor outcome, and higher mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Tasneem F Hasan; Nathaniel Todnem; Neethu Gopal; David A Miller; Sukhwinder S Sandhu; Josephine F Huang; Rabih G Tawk Journal: Curr Cardiol Rep Date: 2019-08-30 Impact factor: 2.931
Authors: Andreas Simgen; Michael Kettner; Frida Juliane Webelsiep; Toshiki Tomori; Ruben Mühl-Benninghaus; Umut Yilmaz; Pervinder Bhogal; Matthias W Laschke; Michael D Menger; Wolfgang Reith; Philipp Dietrich Journal: Clin Neuroradiol Date: 2020-05-18 Impact factor: 3.649
Authors: Andreas Simgen; Michael Kettner; Philipp Dietrich; Toshiki Tomori; Ruben Mühl-Benninghaus; Pervinder Bhogal; Matthias W Laschke; Michael D Menger; Wolfgang Reith; Umut Yilmaz Journal: Clin Neuroradiol Date: 2020-03-12 Impact factor: 3.649
Authors: Tareq Meyer; Omid Nikoubashman; Lisa Kabelitz; Marguerite Müller; Ahmed Othman; Saif Afat; Martin Kramer; Martin Wiesmann; Marc A Brockmann; Carolin Brockmann Journal: PLoS One Date: 2017-05-25 Impact factor: 3.240
Authors: Francesco Briganti; Giuseppe Leone; Mariano Marseglia; Carmela Chiaramonte; Domenico Solari; Ferdinando Caranci; Paolo Cappabianca; Francesco Maiuri Journal: NMC Case Rep J Date: 2016-09-01