J Cerebrovasc Endovasc Neurosurg.  2012 Sep;14(3):203-209. 10.7461/jcen.2012.14.3.203.

The Limitations of Thrombectomy with Solitaire(TM) AB as First-line Treatment in Acute Ischemic Stroke: A Single Center Experience

• Kim TK
• Rhim JK
• Lee CJ
• Oh SH
• Chung BS

• KMID: 1808456
• DOI: http://doi.org/10.7461/jcen.2012.14.3.203

Abstract

OBJECTIVE
A self-expanding retrievable intracranial stent, such as Solitaire AB, is useful for mechanical thrombectomy, producing novel results in the treatment of acute ischemic stroke. On the other hand, difficult situations can arise after a thrombectomy when using as in first-line treatment.
METHODS
This was a retrospective, single-center study of 23 patients with an acute ischemic stroke attributable to a large artery occlusion within the first eight hours from symptom onset. The occlusion sites were the T segment in five patients, proximal middle cerebral artery in six patients, distal middle cerebral artery in three patients, vertebral and/or basilar artery in five patients, proximal internal cerebral artery in one patient and tandem in three patients. All patients underwent a mechanical thrombectomy using the Solitaire(TM) stent system as the first-line treatment but required additional procedures due to the unsatisfactory results of a thrombectomy.
RESULTS
Only six patients achieved complete recanalization by a thrombectomy using the Solitaire. Permanent stent deployment after the thrombectomy was performed in ten patients. Stent and balloon angioplasty was performed after a stent-based thrombectomy in six patients. Balloon angioplasty after thrombectomy was performed in one patient.
CONCLUSION
Mechanical thrombectomy with the Solitaire(TM) stent as a first-line treatment can produce unfortunate results that will require additional procedures.

Keyword

Atherosclerosis; Intervention; Stent; Stroke; Thrombectomy

MeSH Terms

Angioplasty, Balloon
Arteries
Atherosclerosis
Basilar Artery
Cerebral Arteries
Hand
Humans
Middle Cerebral Artery
Retrospective Studies
Stents
Stroke
Thrombectomy

Figure

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  Fig. 1 Revascularization procedure

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  Fig. 2 Occlusion of the middle cerebral artery. Symptom onset at 30 minutes before angiography. The National Institute of Health Stroke Scale score (NIHSS) score was 15. Antero-posterior view of a left middle cerebral artery angiogram depicts a thrombus in the proximal middle cerebral artery (arrow) (A). Solitaire AB stent deployment (B). Solitaire AB Device with a captured thrombus (C). Complete recanalization after stent retrieval. The time to recanalization was 40 minutes (D).

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  Fig. 3 Occlusion of the right middle cerebral artery. Symptom onset at 12 hours before angiography. The NIHSS score was 17. Antero-posterior view of the right middle cerebral artery angiogram presents the occlusion in the proximal middle cerebral artery (A). Solitaire AB stent deployment (B), Early recanalization after stenting (C). Re-occlusion after retrieval (D). Enterprise stent deployment and balloon angioplasty (E). Complete recanalization after stenting and angioplasty (F).

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