Treatment of acute middle cerebral artery occlusion with a Solitaire AB stent: preliminary experience

Abstract

We report our initial experience with a Solitaire AB neurovascular remodeling stent device in performing cerebral embolectomy in seven patients presenting to our institution with acute stroke who were resistant to iv thrombolytic drug treatment. The main inclusion criteria were: National Institutes of Health Stroke Scale (NIHSS) score ≥10; treatment performed within 8 h from the onset of symptoms and no large hypodensity on CT; and occlusion of a major cerebral artery on the CT angiogram. An admission and a post-interventional NIHSS score were calculated for all patients by two different neurologists. Efficacy was assessed radiologically by post-treatment thrombolysis in myocardial infarction (TIMI) scores and clinically by a 30-day Modified Rankin Scale (MRS) score. The mean duration of neurointerventional treatment was 84 min. All interventions were successful, with TIMI scores of 2 or 3 achieved in 100% of patients. There was one procedural complication in our series owing to a self-detached stent and one patient had a small asymptomatic basal ganglia haemorrhage. There was improvement of more than 4 points on the NIHSS score in 5 (72%) of the patients following treatment, of whom 4 (57%) had a 30-day MRS score of ≤2. The use of a Solitaire stent in acute stroke was safe, time-efficient and encouraging; however, a larger sample size will be required to further evaluate the use of this device, which could benefit a significant number of stroke patients.

Figure 1

Thrombus seen entangled within the meshwork of the Solitaire AB stent (red arrows).

Figure 2

(a and b) Initial angiogram (Towne's and lateral views) demonstrating the occlusion of the M1 segment of the right middle cerebral artery (MCA) (black arrow). (c) Placement of the Rebar 27 microcatheter just distal to the clot (black arrow). (d and e) Deployment of the Solitaire stent within the thrombus (black arrow). (f) Administration of intra-arterial tissue plasminogen activator through the microcatheter with the stent in situ (black arrow). (g and h) Immediate post-treatment angiogram showing complete revascularisation of the previously occluded right MCA.