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Hofmeister J, Brina O, Bernava G, Rosi A, Reymond P, Lovblad KO, Machi P. Double Stent Retriever Technique for Mechanical Thrombectomy: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2024; 45:1031-1037. [PMID: 38521091 PMCID: PMC11383395 DOI: 10.3174/ajnr.a8253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Mechanical thrombectomy using a double stent retriever technique has recently been described for the treatment of acute ischemic stroke, but its efficacy and safety are not well-established. PURPOSE The aim of this systematic review and meta-analysis was to evaluate reports of the use of a double stent retriever technique during the endovascular treatment of patients with ischemic stroke. DATA SOURCES The PubMed, EMBASE, Web of Science, and Scopus databases were searched to identify all studies (clinical trials, cohort series, and case reports) investigating the utility of a double stent retriever technique for the treatment of stroke. The study is reported in accordance with PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD42023482691). STUDY SELECTION Seventeen studies involving a total of 128 patients with large-vessel occlusions predominantly in the anterior circulation (93.0%) were identified. DATA ANALYSIS Outcomes of interest were the prevalence of successful recanalization (modified TICI ≥2b) and a first-pass effect following the double stent retriever technique as well as complications such as iatrogenic dissections and SAH. Data were pooled using a random effects model. DATA SYNTHESIS The double stent retriever technique was used as a rescue strategy in occlusions refractory to conventional endovascular treatment in 68.7% (88/128) of patients and as a first-line strategy in 31.3% (40/128) of patients. The double stent retriever technique achieved an overall final modified TICI ≥2b in 92.6% cases, with a first-pass effect of 76.6%. The complication rate remained low, with 0.37% dissection and 1.56% SAH. LIMITATIONS Limitations of the study include the following: 1) a large number of case reports or small series, 2) a meta-analysis of proportions with no statistical comparison with a control group, and 3) the lack of access to patient-level data. CONCLUSIONS Our findings suggest that double stent retriever thrombectomy may be safe and associated with good recanalization outcomes, but prospective comparative studies are needed to determine which patients may benefit from this endovascular procedure.
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Affiliation(s)
- Jeremy Hofmeister
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
- Brain Endovascular Therapeutics Research and Development Lab (J.H., O.B., P.R., K.-O.L., P.M.), Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Olivier Brina
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
- Brain Endovascular Therapeutics Research and Development Lab (J.H., O.B., P.R., K.-O.L., P.M.), Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Gianmarco Bernava
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Rosi
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Reymond
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
- Brain Endovascular Therapeutics Research and Development Lab (J.H., O.B., P.R., K.-O.L., P.M.), Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Karl-Olof Lovblad
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
- Brain Endovascular Therapeutics Research and Development Lab (J.H., O.B., P.R., K.-O.L., P.M.), Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Paolo Machi
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
- Brain Endovascular Therapeutics Research and Development Lab (J.H., O.B., P.R., K.-O.L., P.M.), Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
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Ifergan H, Dargazanli C, Ben Hassen W, Hak JF, Gory B, Ognard J, Premat K, Marnat G, Kerleroux B, Zhu F, Bellanger G, Sporns PB, Charbonnier G, Forestier G, Caroff J, Fauché C, Clarençon F, Janot K, Lapergue B, Boulouis G. Rescue intracranial permanent stenting for refractory occlusion following thrombectomy: a propensity matched analysis. J Neurointerv Surg 2024; 16:115-123. [PMID: 37080770 DOI: 10.1136/jnis-2022-020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/25/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Rescue intracranial stenting (RIS) can be used in refractory large vessel occlusion (LVO) after mechanical thrombectomy (MT). We aimed to assess the safety and efficacy of RIS versus a propensity matched sample of patients with persistent LVO. METHODS We retrospectively analysed a multicenter retrospective pooled cohort of patients with anterior LVO (2015-2021) treated with MT, and identified patients with at least three passes and a modified Thrombolysis In Cerebral Infarction (mTICI) score of 0 to 2a. Propensity score matching was used to account for determinants of outcome in patients with or without RIS. The study outcomes included 3 months modified Rankin Scale (mRS) and symptomatic hemorrhagic transformation (HT). RESULTS 420 patients with a refractory anterior occlusion were included, of which 101 were treated with RIS (mean age 69 years). Favorable outcome (mRS 0-2) was more frequent in patients with a patent stent at day 1 (53% vs 6%, P<0.001), which was independently associated with an early dual antiplatelet regimen (P<0.05). In the propensity matched sample, patients treated with RIS versus without RIS had similar rates of favorable outcomes (36.8% vs 30.3%, P=0.606). Patients with RIS showed a favorable shift in the overall mRS distributions (common adjusted OR 0.74, 95% CI 0.60 to 0.91, P=0.006). Symptomatic HT was marginally more frequent in the RIS group (9% vs 3%, P=0.07), and there was no difference in 3-month mortality. CONCLUSION In selected patients with a refractory intracranial occlusion despite at least three thrombectomy passes, RIS may be associated with an overall shift towards more favorable clinical outcome, and no significant increase in the odds of symptomatic HT or death.
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Affiliation(s)
- Heloise Ifergan
- Diagnostic and Interventional Neuroradiology, University Hospital of Tours, Tours, Centre, France
| | - Cyril Dargazanli
- Diagnostic and Interventional Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
| | - Wagih Ben Hassen
- Diagnostic and Interventional Neuroradiology, Saint Anne Hospital Centre, Paris, France
| | - Jean-Francois Hak
- Diagnostic and Interventional Neuroradiology, Hospital Timone, University Hospital of Marseille, Marseille, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, INSERM U1254, IADI, F-54000, University Hospital of Nancy, Nancy, France
| | - Julien Ognard
- Diagnostic and Interventional Neuroradiology, University and Regional Hospital Centre Brest, Brest, France
| | - Kevin Premat
- Diagnostic and Interventional Neuroradiology, University Hospital of Pitié Salpêtrière, APHP, Paris, France
| | - Gaultier Marnat
- Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Basile Kerleroux
- Diagnostic and Interventional Neuroradiology, Saint Anne Hospital Centre, Paris, France
| | - François Zhu
- Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Guillaume Bellanger
- Diagnostic and Interventional Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Peter B Sporns
- Diagnostic and Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland
| | - Guillaume Charbonnier
- Diagnostic and Interventional Neuroradiology, University Hospital of Besançon, Besancon, France
| | - Géraud Forestier
- Diagnostic and Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
| | - Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Cédric Fauché
- Diagnostic and Interventional Neuroradiology, University Hospital of Poitiers, Poitiers, France
| | - Frédéric Clarençon
- Diagnostic and Interventional Neuroradiology, University Hospital of Pitié Salpêtrière, APHP, Paris, France
| | - Kevin Janot
- Diagnostic and Interventional Neuroradiology, University Hospital of Tours, Tours, Centre, France
| | - Bertrand Lapergue
- Neurology, Stroke Center, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Gregoire Boulouis
- Diagnostic and Interventional Neuroradiology, University Hospital of Tours, Tours, Centre, France
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Vega P, Murias E, Jimenez JM, Chaviano J, Rodriguez J, Calleja S, Delgado M, Benavente L, Castañon M, Puig J, Cigarran H, Arias F, Chapot R. First-line Double Stentriever Thrombectomy for M1/TICA Occlusions : Initial Experiences. Clin Neuroradiol 2022; 32:971-977. [PMID: 35416489 PMCID: PMC9744691 DOI: 10.1007/s00062-022-01161-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/13/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Mechanical thrombectomy is the standard of care for acute ischemic stroke due to large-vessel occlusion; however, mechanical thrombectomy fails to achieve adequate recanalization in nearly one third of these cases. Rescue therapy using two stentrievers simultaneously yields good results in clots refractory to single stentriever treatment. We aimed to determine the safety and efficacy of first-line double stentriever thrombectomy for acute occlusion of the M1 segment of the middle cerebral artery and/or terminal internal carotid artery (TICA). METHODS This single-center study prospectively enrolled consecutive patients with a single M1/TICA occlusion to undergo double stentriever thrombectomy between May and October 2020. Outcomes included successful recanalization (modified thrombolysis in cerebral infarction, TICI 2b/3), first-pass effect, procedure times, number of device passes, symptomatic intracerebral hemorrhage, National Institutes of Health Stroke Scale Score (NIHSS) at discharge, 90-day functional independence (modified Rankin scale 0-2), and 90-day mortality. RESULTS We analyzed 39 patients median age 79 years (range 42-96 years); 23 (58.9%) female; 19 (48.7%) with TICA occlusions; 5 (12.8%) with mRS 3-5 at admission; mean NIHSS at admission, 17 ± 4.39). Mean time from symptom onset to final angiogram was 238.0 ± 94.6 min; mean intervention duration was 36.0 ± 24.2 min. The mean number of device passes was 1.5 ± 1.07. All patients had final TICI 2b/3, and 27 (69%) had TICI 2c/3 after the first pass. We observed 3 (7.9%) cases of intracerebral symptomatic hemorrhages. At 90 days, 16 (41%) patients were functionally independent and 9 (23%) had died. The percentage of patients with good clinical outcome at 90 days was 55.5% in the first-pass subgroup. CONCLUSION Our findings suggest that first-line double stentriever thrombectomy is safe and effective for M1/TICA occlusions.
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Affiliation(s)
- Pedro Vega
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain.
| | - Eduardo Murias
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Jose Maria Jimenez
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Juan Chaviano
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Jose Rodriguez
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Sergio Calleja
- Department of Neurology, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Montserrat Delgado
- Department of Neurology, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Lorena Benavente
- Department of Neurology, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Maria Castañon
- Department of Neurology, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Josep Puig
- IDI-Radiology, Doctor Josep Trueta University Hospital of Girona, Girona, Spain
| | - Helena Cigarran
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Faustino Arias
- Department of Radiology, Hospital Universitario Central de Asturias, Avda. Roma S/N 33011, Oviedo, Asturias, Spain
| | - Rene Chapot
- Department of Neuroradiology and Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus, Essen, Germany
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