Solitaire stent permanent implantation as an effective rescue treatment for emergency large artery occlusion.

Solitaire stent permanent implantation as an effective rescue treatment for emergency large artery occlusion.

World Neurosurg. 2019 Jan 18;:

Authors: Li DD, Huang H, Fang JH, Fu FW, Lin J, Bai GH, Xu SY, Sheng HS, Zhou Q, Zhang N, Yin B

Abstract
BACKGROUND: and Purpose: In this study, we present our experiences of the feasibility of rescue permanent Solitaire stent placement for failed mechanical thrombectomy (MT) and our protocol to avoid useless stent placement.
METHODS: We retrospectively evaluated the data for consecutive patients admitted into the Second Affiliated Hospital of Wenzhou Medical University and two collaboration hospitals from August 2014 to May 2018 for emergency large artery occlusion (ELAO). The baseline clinical characteristics and radiologic assessment, interventional data, clinical outcome and angiographic follow-up data were assessed. Importantly, we introduced our protocol for antegrade flow assessment before Solitaire stent detachment to ensure an effective stent implantation.
RESULTS: Thirty-nine patients (mean age, 68.1 years, mean preprocedural NIHSS, 22.1) were included, whereby 34 patients had anterior circulation LAO and 5 patients posterior circulation LAO. The MT attempts ranged from 1 to 5 (3.6 on average). The mean onset-to-puncture time was 4.8 h (ranging from 2.1 to 7.8 h) and the mean procedure time was 87.4 min (ranging from 32 to 124 min). Modified thrombolysis in cerebral ischemia (mTICI) 2b-3 reperfusion was noted in all cases. The immediate, average postprocedure stenosis rate was 25.3%, and the average stenosis rate at the 3rd-month angiographic follow-up was 34.7% (data from 15 patients). Three patients died. Nineteen patients (48.7%) had good outcome (modified Rankin Scale, mRS ≤ 2) at the 3rd-month.
CONCLUSIONS: Permanent Solitaire stent placement might be a feasible therapy for patients with MT-failed ELAO. For a successful revascularization, careful antegrade flow assessment before stent detachment is critical.

PMID: 30664959 [PubMed - as supplied by publisher]

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