J Korean Neurosurg Soc.  2021 Jan;64(1):30-38. 10.3340/jkns.2020.0046.

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

• Yi HJ
• Sung JH
• Lee DH
• Song SY

• KMID: 2510757
• DOI: http://doi.org/10.3340/jkns.2020.0046

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 firstpass 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.

Keyword

Angiography; Reperfusion; Stents; Stroke; Thrombectomy

Figure

• 

  Fig. 1. Solumbra technique thrombectomy with a Solitaire platinum 4×40 mm stent retriever. A : Initial angiography revealed left M1 occlusion. B : A non-subtracted image showed a deployed Solitaire platinum 4×40 mm stent retriever (black arrow : the proximal end of the working device; black dotted arrow : the distal end of the working device) and a 6 French Catalyst (CAT6) aspiration catheter (white arrow : distal tip of the aspiration catheter). C : Using a weak pull of the Solitaire platinum 4×40 mm stent retriever, the distal tip of the CAT6 aspiration catheter is moved to the proximal end of the working length of the stent retriever. To contact the thrombus, the distal tip of the CAT6 should be placed just proximal to the thrombus (black arrow : the proximal end of the working length of the stent; white arrow : distal tip of the aspiration catheter). D : After retrieval of the Solitaire platinum 4×40 mm and CAT6 with simultaneous aspiration, angiography revealed the complete reperfusion status of the left M1.

• 

  Fig. 2. Representative case of solumbra technique thrombectomy with a Solitaire platinum 4×40 mm stent retriever. A : Roadmap image shows the location of the devices, before their retrieval (black arrow : the proximal end of the working length of the stent; black dotted arrow : mid-portion marker of the stent; white arrow : distal tip of the aspiration catheter). B : By a weak pull of the Solitaire platinum 4×40 mm stent retriever, the distal tip of aspiration catheter (white arrow) should be placed just proximal to the thrombus and between the two markers (black and black dotted arrows) of the Solitaire platinum 4×40 mm stent. C : After retrieval of the Solumbra technique devices, the thrombus was captured by the aspiration catheter and stent retriever. D : Image of the solumbra technique system after retrieval, in which the tip of the aspiration catheter was located distally beyond the midportion marker of the stent retriever.

Reference

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