Introduction: Mechanical thrombectomy is becoming increasingly popular in the management of acute ischemic stroke.This study analyzes the experience of a single center with the Solitaire revascularization device and aims to identify notable factors that affect outcome, revascularization and complications.
Methods: 89 consecutive patients with acute ischemic stroke treated with Solitaire thrombectomy at Jefferson Hospital for Neuroscience were retrospectively analyzed.Three endpoints were considered: revascularization (TIMI grade), outcome (modified rankin scale-mRS at 3 months) and complications including intracerebral hemorrhage and death. Univariate analysis and multivariate logistic regression were conducted to determine the predictors of outcome, revascularization and complications.
Results: The mean patient age was 63 years. 48.3% received intravenous TPA .The mean time from onset of symptoms to start of intervention was 6.7 hours and the mean time from onset to reperfusion was 8 hours. The average procedure length was 58 minutes. The mean NIHSS was 16 on arrival, 12 at 24 hours post thrombectomy and 8 on discharge. 6.7% had a symptomatic intracerebral hemorrhage. 10.1% had fatal outcomes within the same hospitalization. An additional 6.7% mortality was recorded within 3 months post intervention. Higher admission and follow up NIHSS significantly predicted increased rate of overall complications (P=0.05).Thrombus location in the posterior circulation (mortality=33.3%, OR=5.5, P=0.04) and increasing NIHSS (P=0.04) significantly predicted increased mortality.55% of patients had TIMI grade 3 recanalization and 26% had TIMI grade 2. Thrombus location in M1 was significantly associated with TIMI 3 recanalization (OR=4.4, [1.6-11.8], P=0.003).Overall, 55% had favorable outcome (mRS at 3 months: 0-2).In patients <80 years of age, 63% had good outcome.Increasing age (P=0.01) and higher NIHSS (P=0.002) were statistically significant predictors of poor outcome.
Conclusions: The Solitaire device is safe and effective in achieving successful recanalization after acute ischemic stroke especially in M1 occlusion. Important factors to consider in predicting outcome and mortality include age, NIHSS and location.
Patient Care: The analysis of the important predictors of outcome and recanalization of the Solitaire device will help to guide patient selection and identify patients that would benefit the most from this device.
Learning Objectives: By the conclusion of this session, participants should be able to:
1)Describe the importance of age, NIHSS and location in predicting outcome, revascularization and complications of the Solitaire device and describe the importance of mechanical thrombectomy in the management of acute ischemic stroke.
2) Discuss in small groups the efficacy and safety of the Solitaire device and discuss the main predictors of outcome, recanalization and complications that were found to be significant in this study.
3) Identify the Solitaire device as an effective and safe treatment for patients with acute ischemic stroke.