Neurointervention.  2012 Feb;7(1):1-9. 10.5469/neuroint.2012.7.1.1.

Safety and Efficacy of Mechanical Thrombectomy with Solitaire Stent Retrieval for Acute Ischemic Stroke: A Systematic Review

• Koh JS
• Lee SJ
• Ryu CW
• Kim HS

• KMID: 1783992
• DOI: http://doi.org/10.5469/neuroint.2012.7.1.1

Abstract

PURPOSE
In recent years, mechanical thrombectomy using Solitaire stent retrieval has been tried for treating acute ischemic stroke with a large artery occlusion. We systematically reviewed published articles to appraise the evidence that supports the safety and efficacy of the mechanical thrombectomy in acute strokes with Solitaire stent.
MATERIALS AND METHODS
Systematic searches using Medline and Scopus were performed for studies evaluating mechanical thrombectomy using a Solitaire stent in acute ischemic stroke. Articles were included if they were published since 2008, contained at least 5 subjects, and provided clinical results.
RESULTS
Thirteen articles (262 cases) were included in this review. The mean time of the procedures ranged from 37 to 95.6 minutes in 10 studies. The success of recanalization was achieved in 89.7% and the recanalization rate varied from 66.7% to 100% in all 13 studies. The overall rates of the symptomatic hemorrhagic complications and mortality were 6.8% and 11.1%, respectively. A favorable outcome of mRS 2 or under was 47.3%. Procedure-induced complications developed in 3.4%.
CONCLUSION
The present review suggested that mechanical thrombectomy using a Solitaire stent in acute ischemic stroke was effective in recanalizing the occluded artery. The rate of procedural complications was small.

Keyword

Stroke; Mechanical recanalization; Self-expanding stent; Solitaire; Systematic review

MeSH Terms

Arteries
Stents
Stroke
Thrombectomy

Reference

1. Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007; 38:967–973. PMID: 17272772.

2. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in acute cerebral thromboembolism. JAMA. 1999; 282:2003–2011. PMID: 10591382.

3. Cohen JE, Gomori JM, Leker RR, Moscovici S, Ramirez-Denoriega F, Itshayek E. Recanalization with stent-based mechanical thrombectomy in anterior circulation major ischemic stroke. J Clin Neurosci. 2012; 19:39–43. PMID: 22136733.

4. Costalat V, Machi P, Lobotesis K, Maldonado I, Vendrell JF, Riquelme C, et al. 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. 2011; 42:1929–1935. PMID: 21597019.

5. Cohen JE, Leker RR, Moscovici S, Attia M, Itshayek E. Stent-based mechanical thrombectomy in acute basilar artery occlusion. J Clin Neurosci. 2011; 18:1718–1720. PMID: 22001243.

6. Seifert M, Ahlbrecht A, Dohmen C, Spuentrup E, Moeller-Hartmann W. Combined interventional stroke therapy using intracranial stent and local intraarterial thrombolysis (LIT). Neuroradiology. 2011; 53:273–282. PMID: 20556600.

7. Fesl G, Wiesmann M, Patzig M, Holtmannspoetter M, Pfefferkorn T, Dichgans M, et al. Endovascular mechanical recanalisation of acute carotid-T occlusions: a single-center retrospective analysis. Cardiovasc Intervent Radiol. 2011; 34:280–286. PMID: 20936289.

8. Castano C, Serena J, Davalos A. Use of the new Solitaire (TM) AB device for mechanical thrombectomy when Merci clot retriever has failed to remove the clot. A case report. Interv Neuroradiol. 2009; 15:209–214. PMID: 20465901.

9. Mordasini P, Frabetti N, Gralla J, Schroth G, Fischer U, Arnold M, et al. In vivo evaluation of the first dedicated combined flow-restoration and mechanical thrombectomy device in a swine model of acute vessel occlusion. AJNR Am J Neuroradiol. 2011; 32:294–300. PMID: 20966052.

10. Brekenfeld C, Schroth G, Mordasini P, Fischer U, Mono ML, Weck A, et al. Impact of retrievable stents on acute ischemic stroke treatment. AJNR Am J Neuroradiol. 2011; 32:1269–1273. PMID: 21566010.

11. Castano C, Dorado L, Guerrero C, Millan M, Gomis M, Perez de la Ossa N, et al. Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke. 2010; 41:1836–1840. PMID: 20538693.

12. Machi P, Costalat V, Lobotesis K, Lima Maldonado I, Vendrell JF, Riquelme C, et al. Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients. J Neurointerv Surg. 2012; 4:62–66. PMID: 21990438.

13. Menon BK, Kochar P, Ah-Seng A, Almekhlafi MA, Modi J, Wong JH, et al. Initial experience with a self-expanding retrievable stent for recanalization of large vessel occlusions in acute ischemic stroke. Neuroradiology. 2012; 54:147–154. PMID: 21225420.

14. Miteff F, Faulder KC, Goh AC, Steinfort BS, Sue C, Harrington TJ. Mechanical thrombectomy with a self-expanding retrievable intracranial stent (Solitaire AB): experience in 26 patients with acute cerebral artery occlusion. AJNR Am J Neuroradiol. 2011; 32:1078–1081. PMID: 21493763.

15. Mohlenbruch M, Seifert M, Okulla T, Wullner U, Hadizadeh DR, Nelles M, et al. Mechanical thrombectomy compared to local-intraarterial thrombolysis in carotid t and middle cerebral artery occlusions : a single center experience. Clin Neuroradiol. Epub 2011, oct.

16. Mpotsaris A, Bussmeyer M, Loehr C, Oelerich M, Buchner H, Weber W. Mechanical thrombectomy in severe acute stroke: preliminary results of the Solitaire stent. J Neurol Neurosurg Psychiatry. 2012; 83:117–118. PMID: 21212105.

17. Nayak S, Ladurner G, Killer M. Treatment of acute middle cerebral artery occlusion with a Solitaire AB stent: preliminary experience. Br J Radiol. 2010; 83:1017–1022. PMID: 21088087.

18. Park H, Hwang GJ, Jin SC, Jung CK, Bang JS, Han MK, et al. A retrieval thrombectomy technique with the Solitaire stent in a large cerebral artery occlusion. Acta Neurochir (Wien). 2011; 153:1625–1631. PMID: 21479799.

19. Roth C, Papanagiotou P, Behnke S, Walter S, Haass A, Becker C, et al. Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke. 2010; 41:2559–2567. PMID: 20947848.

20. Stampfl S, Hartmann M, Ringleb PA, Haehnel S, Bendszus M, Rohde S. Stent placement for flow restoration in acute ischemic stroke: a single-center experience with the Solitaire stent system. AJNR Am J Neuroradiol. 2011; 32:1245–1248. PMID: 21596812.

21. Wehrschuetz M, Wehrschuetz E, Augustin M, Niederkorn K, Deutschmann H, Ebner F. Early single center experience with the Solitaire thrombectomy device for the treatment of acute ischemic stroke. Interv Neuroradiol. 2011; 17:235–240. PMID: 21696665.

22. Fitzsimmons BF, Becske T, Nelson PK. Rapid stent-supported revascularization in acute ischemic stroke. AJNR Am J Neuroradiol. 2006; 27:1132–1134. PMID: 16687558.

23. Levy EI, Ecker RD, Hanel RA, Sauvageau E, Wehman JC, Guterman LR, et al. Acute M2 bifurcation stenting for cerebral infarction: lessons learned from the heart: Technical case report. Neurosurgery. 2006; 58:E588. PMID: 16528156.

24. Levy EI, Ecker RD, Horowitz MB, Gupta R, Hanel RA, Sauvageau E, et al. Stent-assisted intracranial recanalization for acute stroke: early results. Neurosurgery. 2006; 58:458–463. PMID: 16528185.

25. Levy EI, Mehta R, Gupta R, Hanel RA, Chamczuk AJ, Fiorella D, et al. Self-expanding stents for recanalization of acute cerebrovascular occlusions. AJNR Am J Neuroradiol. 2007; 28:816–822. PMID: 17494649.

26. Zaidat OO, Wolfe T, Hussain SI, Lynch JR, Gupta R, Delap J, et al. Interventional acute ischemic stroke therapy with intracranial self-expanding stent. Stroke. 2008; 39:2392–2395. PMID: 18556584.

27. Suh SH, Kim BM, Roh HG, Lee KY, Park SI, Kim DI, et al. Self-expanding stent for recanalization of acute embolic or dissecting intracranial artery occlusion. AJNR Am J Neuroradiol. 2010; 31:459–463. PMID: 19892814.

28. Suh SH, Lee KY, Hong CK, Kim BM, Kim CH, Chung TS, et al. Temporary stenting and retrieval of the self-expandable, intracranial stent in acute middle cerebral artery occlusion. Neuroradiology. 2009; 51:541–544. PMID: 19424689.

29. Liebig T, Lockau H, Dorn F, Miloslavski E, Henkes H. Stenting of thromboembolic stroke using a fully retrievable self expanding stent. Proceedings of the ABC-WIN Meeting of the World Federation of Interventional and Therapeutic Neuroradiology. 11-16 January 2009; Val d'Isere, France.

30. Klisch J, Eger C, Sychra V, Strasilla C, Basche S, Weber J. Stent-assisted coil embolization of posterior circulation aneurysms using Solitaire AB: preliminary experience. Neurosurgery. 2009; 65:258–266. discussion 266. PMID: 19625903.

31. Lindsberg PJ, Mattle HP. Therapy of basilar artery occlusion: a systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke. 2006; 37:922–928. PMID: 16439705.

32. Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, et al. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke. 2008; 39:1205–1212. PMID: 18309168.

33. Shi ZS, Loh Y, Walker G, Duckwiler GR. Clinical outcomes in middle cerebral artery trunk occlusions versus secondary division occlusions after mechanical thrombectomy: pooled analysis of the mechanical embolus removal in cerebral ischemia (MERCI) and Multi MERCI trials. Stroke. 2010; 41:953–960. PMID: 20378867.

34. 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. 2009; 40:2761–2768. PMID: 19590057.

35. Baker WL, Colby JA, Tongbram V, Talati R, Silverman IE, White CM, et al. Neurothrombectomy devices for the treatment of acute ischemic stroke: state of the evidence. Ann Intern Med. 2011; 154:243–252. PMID: 21242342.