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Bogicevic D, Vitosevic F, Milosevic Medenica S, Kalousek V, Vukicevic M, Rasulic L. Direct Aspiration Thrombectomy in the Management of Procedural Thromboembolic Complications Related to Endovascular Brain Aneurysm Treatment. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1034. [PMID: 39064463 PMCID: PMC11278664 DOI: 10.3390/medicina60071034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 07/28/2024]
Abstract
Despite growing evidence over the last few years of the efficacy and safety of direct thrombus aspiration using a large bore distal access catheter as a type of mechanical thrombectomy procedure in acute stroke large-vessel occlusion patients, the experience and evidence of this technique for managing thromboembolic complications in endovascular aneurysm treatment is still limited and little research is available regarding this topic. We present a case of a thromboembolic occlusion of the left middle cerebral artery during the preprocedural angiograms of a large and fusiform left internal carotid artery aneurysm. This complication was successfully managed by navigating an already-placed distal access catheter intended for support during the opening of the flow-diverting stent; therefore, the thrombus was manually aspirated for two minutes, and Thrombolysis in Cerebral Infarction (TICI) scale 3 flow was restored. This case should encourage the use of a distal access catheter, already placed for aneurysm treatment, to perform zero-delay direct thrombus aspiration as a rescue approach for thromboembolic complications during endovascular treatments.
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Affiliation(s)
- Damljan Bogicevic
- Special Hospital for Cerebrovascular Diseases “Sveti Sava”, 11000 Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Filip Vitosevic
- Special Hospital for Cerebrovascular Diseases “Sveti Sava”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | - Vladimir Kalousek
- University Clinical Hospital Center ‘Sisters of Mercy’, 10000 Zagreb, Croatia
| | - Marjana Vukicevic
- Special Hospital for Cerebrovascular Diseases “Sveti Sava”, 11000 Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Lukas Rasulic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Kosty JA, Carroll CP, Kandregula S, Plummer Z, Grossman AW, Abruzzo TA, Dossani RH, Ringer AJ. Diminishing returns with successive device passes in mechanical thrombectomy for stroke. Clin Neurol Neurosurg 2021; 208:106780. [PMID: 34365239 DOI: 10.1016/j.clineuro.2021.106780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/07/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multiple device passes are associated with complications and poor functional outcomes following mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO). OBJECTIVE To characterize the relationship between number of device passes, complications, angiographic outcomes, and clinical outcomes in MT for ELVO. METHODS This is a single-center, retrospective cohort study. Individual device passes for MT were evaluated for any change in Thrombolysis in Cerebral Infarction (TICI) score, successful revascularization (TICI 2b or 3), and complications. Outcomes were compared among groups requiring multiple passes with various cut-off points. Risk factors for unfavorable clinical outcome [90 day modified Rankin Scale > 2] were assessed using multivariate analysis. RESULTS Successful revascularization was achieved in 75% of 163 patients and 36% required only one device pass. After the second pass, the likelihood of angiographic improvement significantly decreased (p < 0.001). Using multiple cut-off points, higher post-procedural NIHSS scores, mortality rates, and unfavorable 90-day outcomes were associated with a greater number of passes. Multivariate analysis revealed ICA thrombus (comparison: M2, OR: 25, 95% CI 2-275, p = 0.01) and failed revascularization (OR: 68, 95% CI 3.12-1489, p = 0.01) as the only significant predictors of unfavorable clinical outcome. Nonetheless, the likelihood of favorable clinical outcome was higher in patients with an ICA occlusion who were revascularized in < 2 vs. ≥ 2 (44 vs 4%, p = 0.01) or < 3 vs. ≥ 3 (32 vs. 0%, p = 0.02) passes. CONCLUSION The likelihood of angiographic improvement in patients with ELVO significantly decreases after the second pass. A greater number of passes is associated with worsened clinical outcomes.
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Affiliation(s)
- Jennifer A Kosty
- Department of Neurosurgery, Ochsner LSU Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | | | - Sandeep Kandregula
- Department of Neurosurgery, Ochsner LSU Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Zachary Plummer
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Aaron W Grossman
- Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Todd A Abruzzo
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Rimal H Dossani
- Department of Neurosurgery, Ochsner LSU Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Andrew J Ringer
- Department of Neurosurgery, Good Samaritan Hospital, Cincinnati, OH, USA; Mayfield Clinic, Cincinnati, OH, USA
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Pilgram-Pastor SM, Piechowiak EI, Dobrocky T, Kaesmacher J, Den Hollander J, Gralla J, Mordasini P. Stroke thrombectomy complication management. J Neurointerv Surg 2021; 13:912-917. [PMID: 34158401 PMCID: PMC8458081 DOI: 10.1136/neurintsurg-2021-017349] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/11/2021] [Indexed: 11/04/2022]
Abstract
Endovascular mechanical thrombectomy (EVT) is widely accepted as the first-line treatment for acute ischemic stroke in patients with large vessel occlusion. Being an invasive treatment, this method is associated with various preoperative, perioperative, and postoperative complications. These complications may influence peri-interventional morbidity and mortality and therefore treatment efficacy and clinical outcome. The aim of this review is to discuss the most common types of complications associated with EVT, the probable mechanisms of injury, and effective methods to manage and prevent complications.
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Affiliation(s)
- Sara M Pilgram-Pastor
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Eike I Piechowiak
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Tomas Dobrocky
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Juergen Den Hollander
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Jan Gralla
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Department for Diagnostic and Interventional Neuroradiology, Inselspital Universitatsspital Bern, Bern, Switzerland
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Simgen A, Kettner M, Webelsiep FJ, Tomori T, Mühl-Benninghaus R, Yilmaz U, Bhogal P, Laschke MW, Menger MD, Reith W, Dietrich P. Solitaire Stentectomy Using a Stent-Retriever Technique in a Porcine Model. Clin Neuroradiol 2020; 31:475-482. [PMID: 32424667 PMCID: PMC8211602 DOI: 10.1007/s00062-020-00906-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/15/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Mechanical thrombectomy using the Solitaire device has become a standard treatment of ischemic stroke due to large vessel occlusions. Inadvertent detachment is a feared complication, which is associated with poor clinical outcome. The aim of this experimental study was to assess in a porcine model the feasibility and effectiveness of rescuing detached Solitaire devices using different stent retrievers. METHODS Solitaire FR devices (4 × 15/20 mm and 6 × 20/30 mm) were placed in the axillary artery of pigs. By means of 3 different stent retrievers (Trevo ProVue; EmboTrap II revascularization device; 3D revascularization device) a total of 24 rescue maneuvers (8 per retriever) were performed by deploying the retrievers within the deployed Solitaire devices and trapping parts of the Solitaire within the microcatheter. Rescue rates, rescue time and complications were assessed. RESULTS Overall stentectomy of the Solitaire devices was successful in all cases (100%). Time of rescue was comparable using the applied stent retrievers (Trevo ProVue; EmboTrap II revascularization device; 3D revascularization device). Complications, such as entrapment of the Solitaire-retriever complex at the intermediate catheter, Solitaire migration, vasospasm, perforation, or dissection were not observed. CONCLUSION Stentectomy of inadvertently detached Solitaire devices using different stent retrievers is a feasible and effective method. Rescue rates and times with the Trevo ProVue, EmboTrap II and 3D revascularization device were comparable.
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Affiliation(s)
- Andreas Simgen
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany.
| | - Michael Kettner
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
| | - Frida Juliane Webelsiep
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
| | - Toshiki Tomori
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
| | - Ruben Mühl-Benninghaus
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
| | - Umut Yilmaz
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Whitechapel Road, E1 1BB, London, UK
| | - Matthias W Laschke
- Institute for Clinical & Experimental Surgery, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael D Menger
- Institute for Clinical & Experimental Surgery, Saarland University Hospital, Homburg/Saar, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
| | - Philipp Dietrich
- Department of Neuroradiology, Saarland University Hospital, Kirrbergerstraße1, 66424, Homburg/Saar, Germany
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Different Rescue Approaches of Migrated Woven Endobridge (WEB) Devices: an Animal Study. Clin Neuroradiol 2020; 31:431-438. [PMID: 32166403 PMCID: PMC8211610 DOI: 10.1007/s00062-020-00893-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/18/2020] [Indexed: 11/10/2022]
Abstract
Purpose Treatment of wide-necked intracranial aneurysms using the Woven Endobridge (WEB) device has become broadly accepted. Feared complications with the potential of increased poor clinical outcome include dislocations and migration of the device. This study was carried out to determine the effectiveness of a variety of different strategies to rescue migrated WEB devices. Methods In a porcine model, WEB devices of different sizes (SL [single layer] 3.5 × 2mm and SL 4.0 × 3 mm, SL 8 × 5 mm and SLS 8 mm [single layer spherical]) were placed into both the subclavian and axillary arteries. A total of 32 rescue maneuvers (8 per rescue device) were performed. Small WEBs were rescued using reperfusion catheters (RC) (SOFIA Plus and JET 7), larger WEBs were rescued using dedicated rescue devices (Microsnare and Alligator). Rescue rates, times, attempts and complications were assessed. Results Rescue attempts of migrated WEBs were successful in all cases (100%). Rescue time (p = 0.421) and attempts (p = 0.619) of small WEBs using RCs were comparable without significant differences. Aspiration alone was not successful for larger WEBs. Rescue of larger WEBs was slightly faster (122.75 ± 41.15 s vs. 137.50 ± 54.46 s) with fewer attempts (1 vs. 1.37) when using the Microsnare compared to the Alligator device. Complications such as entrapment of the WEB in the RCs, vasospasm, perforation, or dissection were not observed. Conclusion Rescue of migrated WEB devices is a feasible and effective method and 100% successful rescue rates and appropriate rescue times can be achieved for small WEBs using RCs and for larger WEBs using dedicated rescue devices (Microsnare and Alligator).
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Breakage and Retrieval of an Aspiration Catheter Coil with a Stent Retriever During Mechanical Thrombectomy. World Neurosurg 2019; 130:54-58. [PMID: 31265926 DOI: 10.1016/j.wneu.2019.06.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/23/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Some mechanical thrombectomy techniques for acute ischemic stroke use a combination of an aspiration catheter and stent retriever. We experienced a rare case of aspiration catheter coil breakage and subsequent retrieval using a stent retriever. CASE DESCRIPTION A 79-year-old man suddenly developed somnolence, global aphasia, and right hemiplegia. Magnetic resonance imaging revealed acute infarction of the left frontal lobe and occlusion of the left common carotid artery. Thus, using an aspiration catheter and a stent retriever, mechanical thrombectomy was performed. The stent retriever was deployed from the middle cerebral artery to the internal carotid artery and retracted into the aspiration catheter placed in the internal carotid artery proximal to the thrombus. The catheter was bent during retraction of the stent retriever. After thrombus aspiration, the internal carotid and anterior and middle cerebral arteries were successfully reperfused; however, the stent retriever captured a broken section of the winding coil of the aspiration catheter. We suspected that an X-ray marker on the stent retriever broke the winding coil at the bent segment of the aspiration catheter and the stent captured the broken coil. CONCLUSIONS The combined use of an aspiration catheter and a stent retriever may cause unexpected device breakage, especially when the catheter is bent.
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Ahmed SU, Mann J, Houde J, Barber E, Kelly ME, Peeling L. Permanent implantation of the Solitaire device as a bailout technique for large vessel intracranial occlusions. J Neurointerv Surg 2018; 11:133-136. [PMID: 30154250 DOI: 10.1136/neurintsurg-2017-013418] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/13/2018] [Accepted: 07/21/2018] [Indexed: 01/11/2023]
Abstract
The Solitaire (Medtronic Inc, Mansfield, Massachusetts, USA) is a stentriever device for endovascular treatment of acute ischemic stroke. Temporary endovascular bypass and mechanical thrombectomy are well-described applications of this device. However, few reports of permanent stent placement have been published. We present a series of five cases in which the Solitaire stent was implanted to restore distal flow after failure of conventional mechanical thrombectomy. All patients presented with large vessel occlusions with thrombi that were resistant to retrieval or suction-aspiration. Immediately after implantation the patients were given a loading dose of abciximab and then transitioned to dual antiplatelet therapy within 24 hours. Our series suggests that permanent deployment of the Solitaire may be considered as a bailout technique in the treatment of cerebral large vessel occlusion. Long-term antiplatelet therapy is required after deployment.
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Affiliation(s)
- Syed Uzair Ahmed
- Division of Neurosurgery and Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jenna Mann
- Division of Neurosurgery and Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jeremie Houde
- Division of Neurosurgery and Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Evan Barber
- Division of Neurosurgery and Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Michael E Kelly
- Division of Neurosurgery and Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lissa Peeling
- Division of Neurosurgery and Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Moshayedi P, Jadhav AP. Direct Aspiration Catheter Fracture and Retrieval during Neurothrombectomy. INTERVENTIONAL NEUROLOGY 2018; 7:148-152. [PMID: 29719552 DOI: 10.1159/000486245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/02/2017] [Indexed: 02/04/2023]
Abstract
Background Application of direct aspiration catheters has revolutionized acute stroke care and has led to significant improvement in clinical outcome with a good safety profile. Catheter fracture and retention is a rare but potentially devastating complication. Case Description Here we present two cases of acute stroke complicated by aspiration catheter fracture and retention. Successful catheter retrieval and revascularization was achieved in both cases. The stenosis or tortuosity of vascular anatomy appears to be the probable contributor to catheter breakage by anchoring the catheter with resultant fracture at the constraint point from catheter withdrawal tensile stress. Conclusion This report describes application of snare devices in retrieving a broken catheter during thrombectomy in the anterior and posterior circulation, and therefore presents a technique that can be safely utilized to address catheter breakage complicating thrombectomy in different vascular anatomic locations.
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Affiliation(s)
- Pouria Moshayedi
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ashutosh P Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Endovascular stentectomy using the snare over stent-retriever (SOS) technique: An experimental feasibility study. PLoS One 2017; 12:e0178197. [PMID: 28542580 PMCID: PMC5444789 DOI: 10.1371/journal.pone.0178197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 05/08/2017] [Indexed: 11/19/2022] Open
Abstract
Feasibility of endovascular stentectomy using a snare over stent-retriever (SOS) technique was evaluated in a silicon flow model and an in vivo swine model. In vitro, stentectomy of different intracranial stents using the SOS technique was feasible in 22 out of 24 (92%) retrieval maneuvers. In vivo, stentectomy was successful in 10 out of 10 procedures (100%). In one case self-limiting vasospasm was observed angiographically as a technique related complication in the animal model. Endovascular stentectomy using the SOS technique is feasible in an experimental setting and may be transferred to a clinical scenario.
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Briganti F, Leone G, Marseglia M, Chiaramonte C, Solari D, Caranci F, Cappabianca P, Maiuri F. Mechanical Thrombectomy in the Treatment of Distal Occlusions during Coil Embolization of Ruptured Intracranial Aneurysms. NMC Case Rep J 2016; 3:115-117. [PMID: 28664011 PMCID: PMC5386161 DOI: 10.2176/nmccrj.cr.2016-0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/17/2016] [Indexed: 11/20/2022] Open
Abstract
The experience in the management of thromboembolic complications of distal vessels during coil embolization using stent-retrievers in the setting of subarachnoid hemorrhage (SAH) is still limited. We report a case of 58-year-old woman with a ruptured small anterior communicating aneurysm who experienced during coil embolization a thromboembolic occlusion of the upper post-bifurcation branch of the middle cerebral artery. Mechanical thrombectomy with a stent-retriever (Solitaire, Covidien, Neurovascular) resulted in complete recanalization of the occluded branch with no ischemic complication. This case should encourage the use of the Solitaire device as an effective rescue strategy in the treatment of distal artery occlusions in the setting of SAH.
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Affiliation(s)
- Francesco Briganti
- Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Giuseppe Leone
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Mariano Marseglia
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Carmela Chiaramonte
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
| | - Domenico Solari
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
| | - Ferdinando Caranci
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
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Parthasarathy R, Gupta V, Goel G, Mahajan A. Solitaire stentectomy: 'deploy and engage' and 'loop and snare' techniques. J Neurointerv Surg 2016; 10:e6. [PMID: 27540091 DOI: 10.1136/neurintsurg-2016-012547.rep] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/04/2022]
Abstract
Solitaire FR stent-based mechanical thrombectomy provides clinical benefit in selected patients with acute ischaemic stroke due to large vessel occlusion. A dreaded device complication that is associated with poor technical and clinical outcome is stent detachment. Retrieval of the detached stent can be technically challenging and has been attempted with variable success. The key benefit of this strategy is the lack of need to administer fibrinolytic/antiplatelet agents that can potentially be catastrophic in the setting of acute stroke. Therefore, retrieval may be preferred to other strategies (balloon angioplasty, lytic/glycoprotein 2b/3a inhibitors administration) to address detached stent. We report two patients in whom the detached stent was retrieved using alternative techniques-'deploy and engage' and 'loop and snare'-as snare retrieval failed.
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Affiliation(s)
| | - Vipul Gupta
- Department of Neurointerventional Surgery, Artemis Hospitals, Sector 51, Gurgaon, Haryana-122001
| | - Gaurav Goel
- Department of Neurointerventional Surgery, Medanta The Medicity, Gurgaon, Haryana, India
| | - Anshu Mahajan
- Department of Neurointerventional Surgery, Medanta The Medicity, Gurgaon, Haryana, India
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Parthasarathy R, Gupta V, Goel G, Mahajan A. Solitaire stentectomy: 'deploy and engage' and 'loop and snare' techniques. BMJ Case Rep 2016; 2016:bcr-2016-012547. [PMID: 27520994 DOI: 10.1136/bcr-2016-012547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Solitaire FR stent-based mechanical thrombectomy provides clinical benefit in selected patients with acute ischaemic stroke due to large vessel occlusion. A dreaded device complication that is associated with poor technical and clinical outcome is stent detachment. Retrieval of the detached stent can be technically challenging and has been attempted with variable success. The key benefit of this strategy is the lack of need to administer fibrinolytic/antiplatelet agents that can potentially be catastrophic in the setting of acute stroke. Therefore, retrieval may be preferred to other strategies (balloon angioplasty, lytic/glycoprotein 2b/3a inhibitors administration) to address detached stent. We report two patients in whom the detached stent was retrieved using alternative techniques-'deploy and engage' and 'loop and snare'-as snare retrieval failed.
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Affiliation(s)
| | - Vipul Gupta
- Department of Neurointerventional Surgery, Artemis Hospitals, Sector 51, Gurgaon, Haryana-122001
| | - Gaurav Goel
- Department of Neurointerventional Surgery, Medanta The Medicity, Gurgaon, Haryana, India
| | - Anshu Mahajan
- Department of Neurointerventional Surgery, Medanta The Medicity, Gurgaon, Haryana, India
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