Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients

Abstract

Background and purpose: Prompt recanalization of cerebral arteries in patients diagnosed with acute ischemic stroke is known to be associated with a better clinical outcome. The aim of this study was to present our initial experience regarding the efficacy and safety of the Solitaire FR as a revascularization device.

Methods: 56 consecutive patients presenting with acute ischemic stroke underwent intra-arterial therapy using the Solitaire FR revascularization device. Immediate angiographic results and early clinical outcomes are presented.

Results: Solitaire FR was successful in achieving recanalization in 50 out of 56 patients (89%) with a final Thrombolysis in Cerebral Infarction score ≥2b. Five out of 56 patients had procedure related complications: two asymptomatic subarachnoid hemorrhages, two thromboembolic events and one symptomatic intracranial hemorrhage (PH2). Thirty patients (53.5%) demonstrated at discharge a National Institutes of Health Stroke Scale Score of ≤1 or an improvement of at least 10 points from baseline, and 26 patients (46%) had a modified Rankin Score ≤2.

Conclusions: Solitaire FR is successful in achieving a high rate of arterial recanalization with a low complication rate. The Solitaire FR is a promising thrombectomy tool with a high degree of effectiveness, safety and ease of use.

Figure 1

Solitaire FR revascularization device is a self-expanding, nitinol system with closed cells and a longitudinal split, overlap design.

Figure 2

(A) A frontal angiogram showing a mid-third basilar artery (BA) occlusion. (B, C) Solitaire FR deployed through the thrombus and allowing partial opacification of the BA. (D) Following the first pass of the Solitaire FR, the left posterior cerebral artery (PCA) remained occluded. (E, F) A second pass in the left PCA resulted in complete recanalization of the BA and its branches (Thrombolysis in Cerebral Infarction 3).

Figure 3

A thromboembolic occlusion of the right anterior cerebral artery (ACA) occurred during clot removal from the ipsilateral carotid termination. (A) Initial frontal angiogram showing a right terminal carotid occlusion. (B) Solitaire FR deployed through the thrombus allowed immediate flow restoration. (C) After Solitaire FR retrieval, the thrombus is removed from the occlusion site. (D, E) Diffusion weighted imaging before and after the procedure shows an extension of ischemic lesion in the right ACA territory.