Introduction: There is limited information regarding patient outcomes following interventions for stroke during the endovascular windows. Studies have suggested that recently approved stent-retrievers are safer and more effective than earlier generation thrombectomy devices. Therefore, we compared our cases treated with the Solitaire-FR device to those treated with MERCI and Penumbra
Methods: Single center retrospective review of 102 consecutive acute stroke patients treated with mechanical thrombectomy devices. Kruskal Wallis tests were performed to examine the relationship of thrombectomy device with the admission characteristics of the patient population and intervention outcomes. When significance was noted, pairwise comparisons were performed using Mann-Whitney. Multivariable models were created to analyze good clinical outcome (mRS<=2) and complete revascularization (TICI=3).
Results: Thrombectomy device had a significant impact on functional independence (mRS<=2) at discharge from the hospital (P=.029). Solitaire-FR resulted in significantly more patients being discharged as functionally independent (10/31;32%) in comparison to patients treated with MERCI (4/44;9%) (P=.016). The rate of good clinical outcome with the Penumbra system (4/27;15%) was not significantly different than Solitaire-FR in univariate analysis (P=.139). The rate of partial to complete revascularization (TICI>=2a) was not significantly different between thrombectomy devices (P=.071). A multivariable model, adjusted for age and admission NIHSS, found the use of Solitaire-FR to improve the odds of good clinical outcome (P=.018) (OR:3.966, 95%CI:1.273-12.359). In addition, a multivariable model, adjusted for clot location, gender, and coronary artery disease, found the use of Solitaire-FR to increase the odds of complete reperfusion (P=.045) (OR:2.706, 95%CI:1.021-7.170).
Conclusions: Multivariable models found the stent-retriever, Solitaire-FR, to be a significant predictor of functional independence at discharge and complete reperfusion. New technology to improve revascularization and patient outcomes following stroke continues to mature but further investigations performed in a randomized trial setting are needed to identify subpopulations that would benefit most from intra-arterial therapy.
Patient Care: This research provides information regarding the benefit of stent-retriever technology over previous generation thrombectomy devices. This adds to the literature by providing evidence that endovascular techniques for ischemic stroke are quickly improving and must be continually studied for patient care.
Learning Objectives: Participants should be able to describe : 1) The increased odds of complete recanalization for acute ischemic stroke patients treated with stent-retrievers in comparison to patients treated with previous generation technology, and 2) The improved odds of functional independence for patients treated with stent-retrievers.