1. 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

2. 57 yo female, NIHSS 22, IV rTPA with no clinical effect

3. LIF and phenox CRC 2/4/22

4. LIF with unfolded Stent: Solitaire in sup. trunc

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

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

7. no LIF, straight MTE

8. delivery and retrieval

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

10. TU Munich 03/2008 – 12/2009 104 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)

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

12. Standard proximal M1-occlusion

13. standard access ?

14. 6F Envoy XB, 035-Terumo GW and 4.4 DAC 115cm

15. Synchro and Prowler Select plus via a DAC

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

17. 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

18. Procedural Data - Solitaire Onset to reperfusion: 56-1031 mean 265 minutes, median 230 minutes 58/104 pts. in combination with IV-Lysis 32/104 pts. LIF and MTE Distribution ACI -TM1M2ACAVA-BA 18546624

19. 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%

20. Solitaire vs. non-Solitaire Chi-Quadrat and Fishers exact test: p = 0.000 20% MORE TICI 2b/3 compared to non-Solitaire cases

21. ART: mean 47min. (5-186), median 38.5min valid nmeanSDmedianmin-max non- Solitaire 4168.049.563.017-307 Solitaire4748.730.844.05-140 total8857.741.553.05-307 P-value of Mann-Whitney-U-Test: p = 0,021

22. 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

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

24. Solitaire: Stent or Retriever ?