Abstract
Mechanical thrombectomy using retrievable stents or stent retriever devices has become the mainstay of intra-arterial therapy for acute ischemic stroke. The recent publication of a series of positive trials supporting intra-arterial therapy as standard of care for the treatment of large vessel occlusion will likely further increase stent retriever use. Rarely, premature stent detachment during thrombectomy may be encountered. In our multicenter case series, we found a rate of detachment of less than 1% (n = 7/1,067), and all were first-generation Solitaire FR devices. A review of the US Food and Drug Administration database of device experience yielded 90 individual adverse reports of detachment. There were 82, 1 and 7 detachments of Solitaire FR (first generation), Solitaire FR2 (second generation) and Trevo devices, respectively. We conclude with a brief overview of the technical and procedural considerations which may be helpful in avoiding this rare complication.
References
1.
Villwock MR, Padalino DJ, Deshaies EM: Trends in mortality following mechanical thrombectomy for the treatment of acute ischemic stroke in the USA. J Neurointerv Surg 2015, Epub ahead of print.
2.
Campbell BCV, Donnan GA, Lees KR, et al: Endovascular stent thrombectomy: the new standard of care for large vessel ischaemic stroke. Lancet Neurol 2015;14:846-854.
3.
Saver JF, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, Clark W, Budzik R, Zaidat OO; SWIFT Trialists: Solitaire flow restoration device versus the Merci Retriever in patients with acute ischemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 2012;380:1241-1249.
4.
Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, Liebeskind DS, Smith WS; TREVO 2 Trialists: Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 2012;380:1231-1240.
5.
Berkhemer OA, Fransen PA, Beumer D, et al: A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11-20.
6.
Goyal M, Demchuk AM, Menon BK, et al; ESCAPE Trial Investigators: Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019-1030.
7.
Campbell BC, Mitchell PJ, Kleinig TJ, et al; EXTEND-IA Investigators: Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372:1009-1018.
8.
Saver JL, Goyal M, Bonafe A, et al; SWIFT PRIME Investigators: Stent-retriever thrombectomy after intravenous t-PA versus t-PA alone in stroke. N Engl J Med 2015;372:2285-2295.
9.
Jovin TG, Chamorro A, Cobo E, et al; REVASCAT Trial Investigators: Thrombectomy within 8 h after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296-2306.
10.
Gascou G, Lobotesis K, Machi P, Maldonado I, Vendrell JF, Riquelme O, et al: Stent retrievers in acute ischemic stroke: complications and failures during the perioperative period. Am J Neuroradiol 2014;35:734-740.
11.
Donnan GA: The impact of MR CLEAN. Int J Stroke 2015;10:139.
12.
FDA: Medical device reporting, MAUDE database. http://www.fda.gov/MedicalDevices/Safety/ReportaProblem (retrieved online February 5, 2015).
13.
Castaño C, Serena J, Dávalos A: Use of the new Solitaire™ AB device for mechanical thrombectomy when Merci Clot Retriever has failed to remove the clot. A case report. Interv Neuroradiol 2009;15:209-214.
14.
Nogueira RG, Levy EI, Gounis M, Siddiqui AH: The Trevo device: preclinical data of a novel stroke thrombectomy device in two different animal models of arterial thrombo-occlusive disease. J Neurointerv Surg 2012;4:295-300.
15.
Mokin M, Dumont TM, Veznedaroglu E, Binning MJ, Liebman KM, et al: Solitaire FR thrombectomy for acute ischemic stroke: retrospective multicenter analysis of early postmarket experience after FDA approval. Neurosurgery 2013, Epub ahead of print.
16.
Zaidat OO, Castonguay AC, Gupta R, et al: North American Solitaire Stent Retriever Acute Stroke registry: post-marketing revascularization and clinical outcome results. J Neurointerv Surg 2014;6:584-588.
17.
Zaidat O, Castonguay A, Veznedaroglu E, et al: P-021 TREVO Stent-Retriever Acute Stroke (TRACK) Post-Marketing Registry: interim revascularization and clinical outcome results compared to TREVO-2 and NASA Registry. J Neurointerv Surg 2014;6(suppl 1):A31-A32.
18.
Dorn F, Stehle S, Lockau H, Zimmer C, Liebig T: Endovascular treatment of acute intracerebral artery occlusions with the Solitaire stent: single-centre experience with 108 recanalization procedures. Cerebrovasc Dis 2012;34:70-77.
19.
Miteff F, Faulder KC, Goh ACC, Steinfort BS, Sue C, Harrington TJ: Mechanical thrombectomy with a self-expanding retrievable intracranial stent (Solitaire AB): experience in 26 patients with acute cerebral artery occlusion. AJNR Am J Neuroradiol 2011;32:1078-1081.
20.
Youn SW, Kim HK: Refinement of a thrombectomy technique to treat acute ischemic stroke: technical note on microcatheter advance during retrieving self-expandable stent. J Korean Soc Radiol 2012;67:1-6.
21.
Kwon HJ, Chueh JY, Puri AS, Koh HS: Early detachment of the Solitaire stent during thrombectomy retrieval: an in vitro investigation. J Neurointerv Surg 2015;7:114-117.
22.
Akpinar S, Yilmaz G: Spontaneous Solitaire™ AB thrombectomy stent detachment during stroke treatment. Cardiovasc Intervent Radiol 2015;38:475-478.
23.
Heck DV, Brown MD: Carotid stenting and intracranial thrombectomy for treatment of acute stroke due to tandem occlusions with aggressive antiplatelet therapy may be associated with a high incidence of intracranial hemorrhage. J Neurointerv Surg 2015;7:170-175.
24.
Liu KC, Ding D, Starke RM, Geraghty SR, Jensen ME: Intraprocedural retrieval of migrated coils during endovascular aneurysm treatment with the Trevo Stentriever device. J Clin Neurosci 2014;21:503-506.
25.
Kabbani MR, Smith A, Leider M: Endovascular coil retrieval using a TrevoProVue stentriever. BMJ Case Rep 2014;2014:bcr2014011181.
26.
Kang DH, Park J, Hwang YH, Kim YS: Inadvertent self-detachment of Solitaire AB stent during the mechanical thrombectomy for recanalization of acute ischemic stroke: lessons learned from the removal of stent via surgical embolectomy. J Korean Neurosurg Soc 2013;53:360-363.
27.
Adams H, Effron M, Torner J, et al: Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of an international phase III trial: AbESST-II. Stroke 2008;39:87-99.
© 2015 S. Karger AG, Basel
2015
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