P61 Double stent-retriever as first-line approach in mechanical thrombectomy – a randomized in vitro evaluation. (29th August 2022)

• Record Type: Journal Article
• Authors: Li, J; Tiberi, R; Vargas, D; Tomasello, A; Ribo, M
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 2
• Page Start: A32
• Page End: A33
• Publication Date: 2022-08-29
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-ESMINT.82
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Introduction: Repeated number of passes during mechanical thrombectomy (MT) leads to worse clinical outcomes in acute ischemic stroke. Previous studies suggested simultaneous double stent-retriever (SR) as a rescue technique when single-SR fails. We aim to investigate the potential benefits of the primary double-SR technique. Aim of the Study: To compare the rate of first-pass recanalization (%FPE) with double-SR vs single-SR technique. Methods: Three types of clot analogs (soft and elastic, stiff, and fragment-prone) were used to create terminal internal carotid artery (T-ICA, N=44) and middle cerebral artery (MCA, N=58) occlusions in the left (2 co-dominant M2 branches, N=56 experiments) and right sides (1 dominant M2 branch, N=46) of an in vitro neurovascular model. After embolization, MT technique was randomly (1:1) assigned: single-SR or double-SR, in combination with a 0.071'' distal aspiration catheter. Results: FPE was achieved in 43.1% of MT procedures (44/102). Overall, double-SR achieved a non-significantly higher%FPE than single-SR (49% vs. 37.2%, p=0.230). The difference between techniques was not clearly evidenced on the right side of the anatomy (39.1% vs 47.8%; p=0.552). However, double-SR significantly outperformed single-SR on the left side (57.1% vs 28.6%, p=0.031), where 25% of MCA occlusions (10/40) extended into both M2 divisions, and the presence of the saddle thrombus lead to procedural failure of single-SR. Conclusions: Under certain anatomical conditions, the double-SR technique combined with distal aspiration may induce a higher%FPE than single-SR. The perks of using double-SR as the primary approach are highlighted when treating saddle occlusions. References: Klisch J, Sychra V, Strasilla C, et al . Double solitaire mechanical thrombectomy in acute stroke: effective rescue strategy for refractory artery occlusions? Ajnr Am J Neuroradiol 2015;36:552–6. Doi:10.3174/Ajnr.A4133 Asadi H, Brennan P, Martin A, Looby S, O'hare A, Thornton J. Double stent-retriever technique in endovascular treatment of middle cerebral artery saddle embolus. J Stroke Cerebrovasc Dis 2016;25:E9–11. Doi:10.1016/J. Jstrokecerebrovasdis.2015.10.005 Do you have any conflict of interest to declare? : No