Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Effectiveness and Technical Considerations of Solitaire Platinum 4×40 mm Stent Retriever in Mechanical Thrombectomy with Solumbra Technique

  • Yi, Ho Jun (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sung, Jae Hoon (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Dong Hoon (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Song, Seung Yoon (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2020.02.21
  • Accepted : 2020.04.01
  • Published : 2021.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The Solitaire Platinum 4×40 mm stent retriever contains radiopaque markers with a long length. We evaluated the effect of Solitaire Platinum 4×40 mm stent retriever in Solumbra technique thrombectomy, and compared it with shorter Solitaire stent retrievers. Methods : A total of 70 patients who underwent Solumbra technique thrombectomy with equal diameter (4 mm) and different length (40 vs. 20 mm) Solitaire stent retrievers were divided into two groups : the Solitaire Platinum 4×40 mm stent (4×40) group and the Solitaire FR 4×20 mm stent or Solitaire Platinum 4×20 mm stent (4×20) group. The clinical outcomes, Thrombolysis in Cerebral Infarction score, the first pass reperfusion status, and complications were evaluated and compared between the two groups. Multivariate analysis was performed to evaluate the predictive factors for reperfusion and complete reperfusion from the first pass. Results : Higher first-pass reperfusion and complete reperfusion were achieved in the 4×40 group (68.0% and 48.0%) than in the 4×20 group (46.7% and 33.3%; p=0.004 and 0.007, respectively). In multivariate analysis, radiopaque device and longer stent retriever were correlated with first-pass reperfusion (p=0.014 and 0.008, respectively) and first-pass complete reperfusion (p=0.022 and 0.012, respectively). Conclusion : Our study demonstrated the usefulness of the Solitaire Platinum 4×40 mm stent retriever, which led to higher first-pass reperfusion and complete reperfusion rates than the Solitaire FR 4×20 mm stent or the Solitaire Platinum 4×20 mm stent, especially in Solumbra technique thrombectomy.

Keywords

References

  1. Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG : Classification of stroke subtypes. Cerebrovasc Dis 27 : 493-501, 2009 https://doi.org/10.1159/000210432
  2. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. : A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372 : 11-20, 2015 https://doi.org/10.1056/NEJMoa1411587
  3. Bourcier R, Saleme S, Labreuche J, Mazighi M, Fahed R, Blanc R, et al. : More than three passes of stent retriever is an independent predictor of parenchymal hematoma in acute ischemic stroke. J Neurointerv Surg 11 : 625-629, 2019 https://doi.org/10.1136/neurintsurg-2018-014380
  4. Bracard S, Ducrocq X, Mas JL, Soudant M, Oppenheim C, Moulin T, et al. : Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol 15 : 1138-1147, 2016 https://doi.org/10.1016/S1474-4422(16)30177-6
  5. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. : Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372 : 1009-1018, 2015 https://doi.org/10.1056/NEJMoa1414792
  6. Dargazanli C, Consoli A, Barral M, Labreuche J, Redjem H, Ciccio G, et al. : Impact of modified TICI 3 versus modified TICI 2b reperfusion score to predict good outcome following endovascular therapy. AJNR Am J Neuroradiol 38 : 90-96, 2017 https://doi.org/10.3174/ajnr.A4968
  7. Dargazanli C, Fahed R, Blanc R, Gory B, Labreuche J, Duhamel A, et al. : Modified thrombolysis in cerebral infarction 2C/thrombolysis in cerebral infarction 3 reperfusion should be the aim of mechanical thrombectomy: insights from the ASTER trial (contact aspiration versus stent retriever for successful revascularization). Stroke 49 : 1189-1196, 2018 https://doi.org/10.1161/STROKEAHA.118.020700
  8. Deshaies EM : Tri-axial system using the Solitaire-FR and Penumbra Aspiration Microcatheter for acute mechanical thrombectomy. J Clin Neurosci 20 : 1303-1305, 2013 https://doi.org/10.1016/j.jocn.2012.10.037
  9. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. : Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372 : 1019-1030, 2015 https://doi.org/10.1056/NEJMoa1414905
  10. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. : Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387 : 1723-1731, 2016 https://doi.org/10.1016/S0140-6736(16)00163-X
  11. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. : Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359 : 1317-1329, 2008 https://doi.org/10.1056/NEJMoa0804656
  12. Haussen DC, Al-Bayati AR, Grossberg JA, Bouslama M, Barreira C, Bianchi N, et al. : Longer stent retrievers enhance thrombectomy performance in acute stroke. J Neurointerv Surg 11 : 6-8, 2019 https://doi.org/10.1136/neurintsurg-2018-013918
  13. Haussen DC, Lima A, Nogueira RG : The Trevo XP 3×20 mm retriever ('Baby Trevo') for the treatment of distal intracranial occlusions. J Neurointerv Surg 8 : 295-299, 2016 https://doi.org/10.1136/neurintsurg-2014-011613
  14. Hesse AC, Behme D, Kemmling A, Zapf A, Grobe Hokamp N, Frischmuth I, et al. : Comparing different thrombectomy techniques in five largevolume centers: a 'real world' observational study. J Neurointerv Surg 10 : 525-529, 2018 https://doi.org/10.1136/neurintsurg-2017-013394
  15. Hopf-Jensen S, Preib M, Marques L, Lehrke S, Schattschneider J, Stolze H, et al. : Impact and effectiveness of dual aspiration technique in stentassisted mechanical thrombectomy: recent improvements in acute stroke management. Cardiovasc Intervent Radiol 39 : 1620-1628, 2016 https://doi.org/10.1007/s00270-016-1404-4
  16. Humphries W, Hoit D, Doss VT, Elijovich L, Frei D, Loy D, et al. : Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg 7 : 90-94, 2015 https://doi.org/10.1136/neurintsurg-2013-010986
  17. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. : Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372 : 2296-2306, 2015 https://doi.org/10.1056/NEJMoa1503780
  18. Kabbasch C, Mpotsaris A, Chang DH, Hib S, Dorn F, Behme D, et al. : Mechanical thrombectomy with the Trevo ProVue device in ischemic stroke patients: does improved visibility translate into a clinical benefit? J Neurointerv Surg 8 : 778-782, 2016 https://doi.org/10.1136/neurintsurg-2015-011861
  19. Kaesmacher J, Maegerlein C, Zibold F, Wunderlich S, Zimmer C, Friedrich B : Improving mTICI2b reperfusion to mTICI2c/3 reperfusions: a retrospective observational study assessing technical feasibility, safety and clinical efficacy. Eur Radiol 28 : 274-282, 2018 https://doi.org/10.1007/s00330-017-4928-3
  20. Kang DH, Kim YW, Hwang YH, Park J, Hwang JH, Kim YS : Switching strategy for mechanical thrombectomy of acute large vessel occlusion in the anterior circulation. Stroke 44 : 3577-3579, 2013 https://doi.org/10.1161/STROKEAHA.113.002673
  21. Maegerlein C, Berndt MT, Monch S, Kreiser K, Boeckh-Behrens T, Lehm M, et al. : Further development of combined techniques using stent retrievers, aspiration catheters and BGC : the PROTECTPLUS technique. Clin Neuroradiol 30 : 59-65, 2020 https://doi.org/10.1007/s00062-018-0742-9
  22. Maegerlein C, Monch S, Boeckh-Behrens T, Lehm M, Hedderich DM, Berndt MT, et al. : PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy - evaluation of a double embolic protection approach in endovascular stroke treatment. J Neurointerv Surg 10 : 751-755, 2018 https://doi.org/10.1136/neurintsurg-2017-013558
  23. Maus V, Behme D, Kabbasch C, Borggrefe J, Tsogkas I, Nikoubashman O, et al. : Maximizing first-pass complete reperfusion with SAVE. Clin Neuroradiol 28 : 327-338, 2018 https://doi.org/10.1007/s00062-017-0566-z
  24. Maus V, Brehm A, Tsogkas I, Henkel S, Psychogios MN : Stent retriever placement in embolectomy: the choice of the post-bifurcational trunk influences the first-pass reperfusion result in M1 occlusions. J Neurointerv Surg 11 : 237-240, 2019 https://doi.org/10.1136/neurintsurg-2018-014114
  25. Mizokami T, Uwatoko T, Matsumoto K, Ooya Y, Hashimoto G, Koguchi M, et al. : Aspiration Catheter Reach to Thrombus (ART) sign in combined technique for mechanical thrombectomy: impact for first-pass complete reperfusion. J Stroke Cerebrovasc Dis 28 : 104301, 2019 https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.07.017
  26. Nikoubashman O, Alt JP, Nikoubashman A, Büsen M, Heringer S, Brockmann C, et al. : Optimizing endovascular stroke treatment: removing the microcatheter before clot retrieval with stent-retrievers increases aspiration flow. J Neurointerv Surg 9 : 459-462, 2017 https://doi.org/10.1136/neurintsurg-2016-012319
  27. Perez MA, Miloslavski E, Fischer S, Bazner H, Henkes H : Intracranial thrombectomy using the Solitaire stent: a historical vignette. J Neurointerv Surg 4 : e32, 2012 https://doi.org/10.1136/neurintsurg-2011-010149
  28. Pfaff J, Rohde S, Engelhorn T, Doerfler A, Bendszus M, Mohlenbruch MA : Mechanical thrombectomy using the new SolitaireTM Platinum stentretriever : reperfusion results, complication rates and early neurological outcom. Clin Neuroradiol 29 : 311-319, 2019 https://doi.org/10.1007/s00062-017-0657-x
  29. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. : Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372 : 2285-2295, 2015 https://doi.org/10.1056/NEJMoa1415061
  30. Turk AS, Frei D, Fiorella D, Mocco J, Baxter B, Siddiqui A, et al. : ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg 6 : 260-264, 2014 https://doi.org/10.1136/neurintsurg-2014-011125
  31. Yang D, Hao Y, Zi W, Wang H, Zheng D, Li H, et al. : Effect of retrievable stent size on endovascular treatment of acute ischemic stroke: a multicenter study. AJNR Am J Neuroradiol 38 : 1586-1593, 2017 https://doi.org/10.3174/ajnr.A5232
  32. Yi HJ, Lee DH, Sung JH : Clinical usefulness of waiting after stent deployment in mechanical thrombectomy: effect of the clot integration. World Neurosurg 119 : e87-e93, 2018 https://doi.org/10.1016/j.wneu.2018.07.040
  33. Yi HJ, Sung JH, Lee DH, Hong JT, Lee SW : Single-center experience of mechanical thrombectomy with the Trevo XP ProVue 6 × 25 mm stent retriever in middle cerebral artery occlusion: comparison with Trevo XP ProVue 4 × 20 mm. World Neurosurg 107 : 649-656, 2017 https://doi.org/10.1016/j.wneu.2017.08.043
  34. Zaidat OO, Castonguay AC, Linfante I, Gupta R, Martin CO, Holloway WE, et al. : First pass effect: a new measure for stroke thrombectomy devices. Stroke 49 : 660-666, 2018 https://doi.org/10.1161/STROKEAHA.117.020315