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Mechanical thrombectomy in severe acute stroke: preliminary results of the Solitaire stent
  1. Anastasios Mpotsaris,
  2. Matthias Bussmeyer,
  3. Christian Loehr,
  4. Michael Oelerich1,
  5. Helmut Buchner2,
  6. Werner Weber1
  1. 1Klinik für Radiologie, Neuroradiologie und interventionelle Therapie, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
  2. 2Klinik für Neurologie und klinische Neurophysiologie, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
  1. Correspondence to Dr Anastasios Mpotsaris, Klinik für Radiologie, Neuroradiologie und interventionelle Therapie, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Dorstener Str. 151, 45657 Recklinghausen, Germany; mpotsaris{at}unitybox.de

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Introduction

Intravenous recombinant tissue plasminogen activator (rTPA) therapy has limited recanalisation-rates in large artery occlusions (nadir of 5.9% in Carotid-T-Occlusions).1 Therefore, we prospectively evaluated the Solitaire stent (versions AB and FR, ev3 Inc., Plymouth, Minnesota, USA) in mechanical thrombectomy in acute ischaemic stroke.

Materials and methods

Acute stroke patients were triaged on admission for potential mechanical thrombectomy.

Inclusion criteria

  • – Age ≤80

  • – NIHSS score ≥10, less if symptoms were fluctuating

  • – Onset-to-treatment-time ≤4.5 h or secondary worsening (increase in NIHSS score ≥4). When symptom onset was unclear, patients were eligible if there was mismatch between symptoms and CT-scan

  • – Any brainstem syndrome.

Exclusion criteria

  • – Cerebral haemorrhage. Acute infarction >1/3 of middle cerebral artery (MCA) territory on CT-scan.

  • – Prestroke modified Rankin Scale (mRS) score ≥4

Eligible patients had immediate CT-angiography without delaying intravenous rTPA-thrombolysis if applicable according to the guidelines of the German Neurological Society (DGN). In case of occlusion of either the internal carotid artery (ICA), the MCA-M1-segment or the basilar artery (BA) mechanical thrombectomy was carried out. Up to four clot extraction maneuvers were performed. Any preceding stenosis was a priori stented. These patients received intravenous eptifibatide for 24 h to prevent in-stent-thrombosis; its short half-life would allow for emergency decompressive craniectomy. Combination of rTPA and eptifibatide is safe.2

NIHSS and mRS scores were assessed on admission and …

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