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Li X, Feng Y, Gong Y, Chen Y. Assessing the Reproducibility of Research Based on the Food and Drug Administration Manufacturer and User Facility Device Experience Data. J Patient Saf 2024:01209203-990000000-00205. [PMID: 38470959 DOI: 10.1097/pts.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE This article aims to assess the reproducibility of Manufacturer and User Facility Device Experience (MAUDE) data-driven studies by analyzing the data queries used in their research processes. METHODS Studies using MAUDE data were sourced from PubMed by searching for "MAUDE" or "Manufacturer and User Facility Device Experience" in titles or abstracts. We manually chose articles with executable queries. The reproducibility of each query was assessed by replicating it in the MAUDE Application Programming Interface. The reproducibility of a query is determined by a reproducibility coefficient that ranges from 0.95 to 1.05. This coefficient is calculated by comparing the number of medical device reports (MDRs) returned by the reproduced queries to the number of reported MDRs in the original studies. We also computed the reproducibility ratio, which is the fraction of reproducible queries in subgroups divided by the query complexity, the device category, and the presence of a data processing flow. RESULTS As of August 8, 2022, we identified 523 articles from which 336 contained queries, and 60 of these were executable. Among these, 14 queries were reproducible. Queries using a single field like product code, product class, or brand name showed higher reproducibility (50%, 33.3%, 31.3%) compared with other fields (8.3%, P = 0.037). Single-category device queries exhibited a higher reproducibility ratio than multicategory ones, but without statistical significance (27.1% versus 8.3%, P = 0.321). Studies including a data processing flow had a higher reproducibility ratio than those without, although this difference was not statistically significant (42.9% versus 17.4%, P = 0.107). CONCLUSIONS Our findings indicate that the reproducibility of queries in MAUDE data-driven studies is limited. Enhancing this requires the development of more effective MAUDE data query strategies and improved application programming interfaces.
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Affiliation(s)
- Xinyu Li
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yubo Feng
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yang Gong
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
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2
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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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3
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Ziapour B, Zaepfel C, Iafrati MD, Suarez LB, Salehi P. A systematic review of the quality of cardiovascular surgery studies that extracted data from the MAUDE database. J Vasc Surg 2021; 74:1708-1720.e5. [PMID: 33600931 DOI: 10.1016/j.jvs.2021.01.050] [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: 07/27/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate opportunities and limitations of using the Manufacturer and User Facility Device Experience (MAUDE) database for cardiovascular surgery research, we analyzed the quality of studies having ever used MAUDE, in the field of cardiovascular surgery. METHODS We systematically searched the Cochrane Library, PubMed, EMBASE, and Google Scholar for randomized and nonrandomized studies, from inception to July 2019. Two authors evaluated the quality of the retrieved observational studies, according to the National Institutes of Health quality assessment tool for either case series or cross-sectional studies. These tools quantify the quality of case series and cohorts/cross-sectional studies, respectively, with nine and 14 queries. RESULTS Fifty-eight studies were included in the final qualitative review. Of 58 identified studies, 32 were case series, 8 were abstracts of case series, and 13 were reviews or case discussion with an included series from MAUDE. Also, five articles were cross-sectional studies. Of the 32 formal case series, 26 (81%) were found to have poor quality. The most common reasons for a poor quality designation included a lack of consecutive participants, undetermined comparability of participants, and undetermined follow-up adequacy. Only one out of five cross-sectional studies had fair quality; four others were evaluated as poor quality studies. CONCLUSIONS Cardiovascular surgery studies using the MAUDE database, whether case series or cross-sectional design, are mostly of poor quality. Their low quality is partly caused by poor study design, but mainly by intrinsic limitations to the MAUDE database: cases recruited are not consecutive; patient characteristics are not detailed enough to allow a meaningful comparison of patient characteristics between different patient entries; outcome measures are unclear; there is a limited follow-up; and time-to-event data are lacking. We conclude that the quality of cardiovascular surgery publications that rely on data from MAUDE could be improved if investigators were to extract all relevant data points from MAUDE entries, then apply standard quality assessment tools in compiling and reporting the data. MAUDE might be improved if it used medical case report standards during the process of reporting and indexing adverse events. To calculate the incidence rate of any adverse event, all event-free cases, as well as all adverse events in patients using a device, are required. Neither of these two variables is available in the MAUDE at the time of writing.
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Affiliation(s)
- Behrad Ziapour
- Department of General Surgery, Allegheny General Hospital, Pittsburgh, Pa
| | | | - Mark D Iafrati
- Division of Vascular Surgery, Cardiovascular Center at Tufts Medical Center, Boston, Mass
| | - Luis B Suarez
- Cardiovascular Center at Tufts Medical Center, Boston, Mass
| | - Payam Salehi
- Division of Vascular Surgery, Cardiovascular Center at Tufts Medical Center, Boston, Mass.
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Sirakov A, Bhogal P, Möhlenbruch M, Sirakov S. Endovascular treatment of patients with intracranial aneurysms: feasibility and successful employment of a new low profile visible intraluminal support (LVIS) EVO stent. Neuroradiol J 2020; 33:377-385. [PMID: 32692304 PMCID: PMC7482042 DOI: 10.1177/1971400920941402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND PURPOSE Low-profile self-expandable stents have increased the number of intracranial aneurysms treated by endovascular means. The new low-profile visible intraluminal support device LVIS EVO (Microvention), the successor of LVIS Jr, is a self-expandable and retrievable microstent system, designed for implantation into intracranial arteries with a diameter up to 2.0 mm. In this retrospective study we aimed to elucidate the technical feasibility and clinical safety of the novel LVIS EVO stent for stent-assisted coil embolisation of intracranial aneurysms. MATERIALS AND METHODS A single centre technical report of the first six consecutive cases of stent-assisted coil embolisation with the novel LVIS EVO stent for the treatment of unruptured or recanalised intracranial aneurysms. Records were made of basic demographics, aneurysmal characteristics, device properties and related technical details, adverse events, clinical outcomes and occlusion rates on available radiological follow-up. RESULTS Six LVIS EVO devices were successfully implanted in all subjects to treat a total number of six intracranial aneurysms. No device-related intraprocedural complications were seen. At early clinical follow-up six out of six (100%) patients had a modified Ranking score of 0-1. Early angiographic and cross-sectional radiological follow-up, available in five out of six (83.3%) of the patients confirmed unchanged aneurysmal occlusion rates. A minor, transitory neurological deficit was recorded in one of the six (16.6%) patients. Mortality was 0%. CONCLUSIONS Preliminary experience in this subset of our patients confirms a notably improved technical behaviour of the novel LVIS EVO stent system when compared to its ancestor LVIS Jr. The enhanced visibility of the stent and the refined delivery/retrieval capabilities of the stent further increase the safety margins of the devices profile, especially in cases of tortuous anatomy.
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Affiliation(s)
- Alexander Sirakov
- Radiology Department, University Hospital Saint Ivan Rilski, Bulgaria
| | - Pervinder Bhogal
- Interventional Neuroradiology Department, The Royal London Hospital, UK
| | | | - Stanimir Sirakov
- Radiology Department, University Hospital Saint Ivan Rilski, Bulgaria
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Elakkad A, Drocton G, Hui F. Endovascular Stroke Interventions: Procedural Complications and Management. Semin Intervent Radiol 2020; 37:199-200. [PMID: 32419733 PMCID: PMC7224977 DOI: 10.1055/s-0040-1709206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Endovascular mechanical thrombectomy has evolved significantly and has become the mainstay and most effective currently available treatment for acute ischemic stroke patients due to large vessel occlusion. Mechanical thrombectomy is presently performed using a stent retriever or stent-like device, an aspiration catheter, or a combination of the two. Much of the literature has focused on the benefits of endovascular mechanical thrombectomy with only limited data about procedural complications and management. Awareness of risk factors and early recognition of these complications can potentially reduce complication rates, improve management, and yield better overall outcomes. In this review, the authors present a description of intraprocedural complications and strategies to prevent and treat these complications.
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Affiliation(s)
- Ahmed Elakkad
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Gerald Drocton
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Ferdinand Hui
- Division of Interventional Neuroradiology, The Johns Hopkins Hospital, Baltimore, Maryland
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Yokoya S, Hino A, Takezawa H, Katsumori T, Goto Y, Hashimoto Y, Oka H. Microsurgical Removal of Snagged Stent Retriever During Endovascular Embolectomy for Acute Ischemic Stroke. World Neurosurg 2018; 111:115-118. [DOI: 10.1016/j.wneu.2017.12.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 10/18/2022]
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Balami JS, White PM, McMeekin PJ, Ford GA, Buchan AM. Complications of endovascular treatment for acute ischemic stroke: Prevention and management. Int J Stroke 2017; 13:348-361. [PMID: 29171362 DOI: 10.1177/1747493017743051] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Endovascular mechanical thrombectomy (MT) for the treatment of acute stroke due to large vessel occlusion has evolved significantly with the publication of multiple positive thrombectomy trials. MT is now a recommended treatment for acute ischemic stroke. Mechanical thrombectomy is associated with a number of intra-procedural or post-operative complications, which need to be minimized and effectively managed to maximize the benefits of thrombectomy. Procedural complications include: access-site problems (vessel/nerve injury, access-site hematoma and groin infection); device-related complications (vasospasm, arterial perforation and dissection, device detachment/misplacement); symptomatic intracerebral hemorrhage; subarachnoid hemorrhage; embolization to new or target vessel territory. Other complications include: anesthetic/contrast-related, post-operative hemorrhage, extra-cranial hemorrhage and pseudoaneurysm. Some complications are life-threatening and many lead to increased length of stay in intensive care and stroke units. Complications increase costs and delay the commencement of rehabilitation. Some may be preventable; the impact of others can be minimized with early detection and appropriate management. Both neurointerventionists and stroke specialists need to be aware of the risk factors, strategies for prevention, and management of these complications. With the increasing use of mechanical thrombectomy for the treatment of acute ischemic stroke, incidence and outcome of complications will need to be carefully monitored by stroke teams. In this narrative review, we examine the frequency of complications of MT in the treatment of acute ischemic stroke with an emphasis on periprocedural complications. Overall, from recent randomized controlled trials, the risk of complications with sequelae for patient from mechanical thrombectomy is ∼15%. We discuss the management of complications and identify areas with limited evidence, which need further research. Search strategy and selection criteria Relevant evidence was found by searches of Medline and Cochrane Library, reference list, cross-referencing and main journal content pages. Search terms included "brain ischemia", "acute ischemic stroke", "cerebral infarction" AND "mechanical thrombectomy", "endovascular therapy", "endovascular treatment", "endovascular embolectomy", "intra-arterial" AND "randomized controlled trial", "non-randomised trials", "observational studies" AND "complications", "procedural complications", "peri-procedural complications", "device-related complications", "management", "treatment", "outcome". The search included only human studies, and was limited to studies published in English between January 2014 and November 2016. The final reference list was selected on the basis of relevance to the topics covered in the Review. Guidelines for management of acute ischaemic stroke by the American Heart Association, the European Stroke Organisation, multi-disciplinary guidelines and the National Institute for Health and Care Excellence (NICE) were also reviewed.
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Affiliation(s)
- Joyce S Balami
- 1 Centre for Evidence Based Medicine, University of Oxford, Oxford, UK.,2 Norfolk and Norwich University Teaching Hospital NHS Trust, Norwich, UK
| | - Philip M White
- 3 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Peter J McMeekin
- 4 School of Health, Community and Education Studies, Northumbria University, London, UK
| | - Gary A Ford
- 5 John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.,6 Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alastair M Buchan
- 7 Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,8 Acute Vascular Imaging Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
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8
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Retrieval of Migrated Volume Coils Using Different Clot Retrievers in a Porcine Model. Clin Neuroradiol 2017; 28:593-600. [DOI: 10.1007/s00062-017-0600-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
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Castaño C, Dorado L, Remollo S, García-Bermejo P, Gomis M, Pérez de la Ossa N, Millán M, García-Sort MR, Hidalgo C, López-Cancio E, Cubells C, Dávalos A. Unwanted detachment of the Solitaire device during mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg 2016; 8:1226-1230. [DOI: 10.1136/neurintsurg-2015-012156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/19/2015] [Accepted: 12/22/2015] [Indexed: 11/04/2022]
Abstract
BackgroundThe use of retrievable stents for endovascular clot retrieval has dramatically improved successful revascularization and clinical outcome in selected patients with acute stroke.ObjectiveTo describe the rate and clinical consequences of unwanted spontaneous detachment of these devices during mechanical thrombectomy.MethodsWe studied 262 consecutive patients treated with the retrievable stent, Solitaire, for acute ischemic stroke between November 2008 and April 2015. Clinical, procedural, and outcome variables were compared between patients with and without unexpected detachment of this device. Detachment was classified as proximal to the stent proximal marker (type A) or distal to the marker (type B). Poor functional outcome was defined as modified Rankin scale score >2 at 90 days.ResultsUnwanted detachment occurred in 6/262 (2.3%) cases, four of type A and two of type B. Stent recovery was possible in three patients, all of ‘type A’, but in none of ‘type B’. The number of prior passes was higher in patients with undesired detachment (3 (2–5) vs 2 (1–3), p=0.007). Detachment was associated with higher rate of symptomatic intracranial hemorrhage (SICH) (33.3% vs 4.3%, p=0.001), poorer outcome (100% vs 54.8%, p=0.028), and higher mortality rate at 90 days (50% vs 17%, p=0.038).ConclusionsUnwanted detachment of a Solitaire is an uncommon complication during mechanical thrombectomy in patients with acute ischemic stroke and is associated with the clot retrieval attempts, SICH, poor outcome, and higher mortality.
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Misaki K, Uchiyama N, Mohri M, Kamide T, Tsutsui T, Kanamori N, Kurokawa K, Nakada M. Pseudoaneurysm formation caused by the withdrawal of a Trevo ProVue stent at a tortuous cerebral vessel: a case report. Acta Neurochir (Wien) 2016; 158:2085-2088. [PMID: 27631972 DOI: 10.1007/s00701-016-2952-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/31/2016] [Indexed: 11/24/2022]
Abstract
This is the first report on the mechanism of pseudoaneurysm formation after withdrawal of a stent retriever. A 79-year-old woman developed cardiogenic embolization of the distal middle cerebral artery (M2). The deployed stent retriever bent because of vessel tortuosity. After withdrawal of the stent with strong resistance, complete revascularization was achieved, but an extravasation was detected at the site. Eight hours after disappearance of the extravasation, re-bleeding occurred with aneurysm-like pooling of contrast media. Direct surgical observation confirmed a pseudoaneurysm formation. The pseudoaneurysm was likely formed by avulsion of a fine vessel during withdrawal of the stent retriever at a tortuous vessel.
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Affiliation(s)
- Kouichi Misaki
- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Naoyuki Uchiyama
- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masanao Mohri
- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tomoya Kamide
- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Taishi Tsutsui
- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Naomi Kanamori
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Keisuke Kurokawa
- Department of Disease Control and Homeostasis, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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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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