The Potential of Stent-Trievers: Experience in 108 Acute Ischemic Stroke Treatments T. Liebig, H. Lockau, S. Stehle, D. Dorn, S. Prothmann, A. Foerschler,

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Presentation transcript:

The Potential of Stent-Trievers: Experience in 108 Acute Ischemic Stroke Treatments T. Liebig, H. Lockau, S. Stehle, D. Dorn, S. Prothmann, A. Foerschler, H. Henkes Klinikum Rechts der Isar, TU Mȕnchen

57 yo female, NIHSS 22, IV rTPA with no clinical effect

LIF and phenox CRC 2/4/22

LIF with unfolded Stent: Solitaire in sup. trunc

...followed by deployment in inferior trunc...

after 30 minutes (20mg rTPA) Concept of temporary bypass

no LIF, straight MTE

delivery and retrieval

Solitaire FR re-establishes flow enhances lysis fragmentation MTE (potential implant, AB)

TU Munich 03/2008 – 12/ Pat. with 108 Occlusions NIHSS pre 15.3 Solitaire only n=25 Multimodal n=83 most frequent: Solitaire and large caliber cath for repeat access and aspiration (42x Penumbra, 20x Concentric DAC) 15/108 as temporary bypass (in the beginning) success vs failure in MTE cases: 83/10 number of passages: 2.46 (median 2, maximal: 12)

Why Solitaire + DAC ? 57 yo female, NIHSS 14 right M1 occlusion 3h from onset and after full IV lysis

Standard proximal M1-occlusion

standard access ?

6F Envoy XB, 035-Terumo GW and 4.4 DAC 115cm

Synchro and Prowler Select plus via a DAC

Solitaire 6/30 anchored in MCA in order to straighten the ICA

Results: Outcome (at hospital Dx) NIHSS reduced 7.8 mean mRS 0-2 total: 25.6% anterior circ. only: 30% mortality: 13/84 anterior circulation 11/24 VA-BA-territory

Procedural Data - Solitaire Onset to reperfusion: mean 265 minutes, median 230 minutes 58/104 pts. in combination with IV-Lysis 32/104 pts. LIF and MTE Distribution ACI -TM1M2ACAVA-BA

Reperfusion TIMI II/III: 92.5% 72.8% TIMI II/III at or after 1. Application (!) TICI 0TICI 1TICI 2aTICI 2bTICI 3 n=6n=2n=15n=32n=52 21%79%

Solitaire vs. non-Solitaire Chi-Quadrat and Fishers exact test: p = % MORE TICI 2b/3 compared to non-Solitaire cases

ART: mean 47min. (5-186), median 38.5min valid nmeanSDmedianmin-max non- Solitaire Solitaire total P-value of Mann-Whitney-U-Test: p = 0,021

Adverse events (procedural) 1 fatal: Rupture of insertion wire with possible perforation at the proximal tip: no SAH/ICH initially but 4h post proc. under GP IIb/IIIa 1 Stent not applicable through mc 1 SAH immediately after stent placement 5 more patients with evidence of hemorrhage at F/U CT but not attributable to Solitaire 4 early cases of clot migration, today avoided by DAC use

Summary effektive: 80% TICI 2b/3 safe: 1/108 serious Solitaire related adverse event fast: significantly shorter DSA to reperfusion time versatile !!!

Solitaire: Stent or Retriever ?