Inadvertent Stent Retriever Detachment: A Multicenter Case Series and Review of Device Experience FDA Reports

Abstract

Mechanical thrombectomy using retrievable stents or stent retriever devices has become the mainstay of intra-arterial therapy for acute ischemic stroke. The recent publication of a series of positive trials supporting intra-arterial therapy as standard of care for the treatment of large vessel occlusion will likely further increase stent retriever use. Rarely, premature stent detachment during thrombectomy may be encountered. In our multicenter case series, we found a rate of detachment of less than 1% (n = 7/1,067), and all were first-generation Solitaire FR devices. A review of the US Food and Drug Administration database of device experience yielded 90 individual adverse reports of detachment. There were 82, 1 and 7 detachments of Solitaire FR (first generation), Solitaire FR2 (second generation) and Trevo devices, respectively. We conclude with a brief overview of the technical and procedural considerations which may be helpful in avoiding this rare complication.

Keywords: Detachment; Mechanical thrombectomy; Solitaire FR device; Stent retriever; Stroke; Trevo device.

Fig. 1

Successful retrieval of a detached thrombus-laden stent retriever using a MERCI Retriever device in a 62-year-old man presenting with right middle cerebral artery syndrome (NIHSS score 15). After successful proximal carotid artery stenting and mechanical thrombectomy, the 4 × 20 mm Solitaire FR device detached above the carotid stent.

Fig. 2

Number of MAUDE database entries by stent retriever device.

Fig. 3

Stent retriever device detachments by number of retrieval passes.

Fig. 4

Right internal carotid artery angiography (ICA; anteroposterior projection) of an 86-year-old woman presenting with right middle cerebral artery (MCA) syndrome (NIHSS score 23). The images (from left to right) demonstrate right ICA angiography showing proximal MCA occlusion, the third deployment of a 4 × 20 mm Solitaire FR device and subsequent detachment (arrow) of the stent retriever in the proximal MCA with persistent branch occlusion.