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Mechanical thrombectomy with the Solitaire AB device in large intracerebral artery occlusions

Authors

  • John J McCabe MB BCh BAO,

    Corresponding author
    • Neurological Intervention & Imaging Service of Western Australia (NIISWA), Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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  • Timothy J Phillips MBBS FRANZCR,

    1. Neurological Intervention & Imaging Service of Western Australia (NIISWA), Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
    2. Neurological Intervention & Imaging Service of Western Australia (NIISWA), Royal Perth Hospital, Perth, Western Australia, Australia
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  • Con Phatouros MBBS FRANZCR,

    1. Neurological Intervention & Imaging Service of Western Australia (NIISWA), Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
    2. Neurological Intervention & Imaging Service of Western Australia (NIISWA), Royal Perth Hospital, Perth, Western Australia, Australia
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  • Tejinder Singh MBBS FRANZCR,

    1. Neurological Intervention & Imaging Service of Western Australia (NIISWA), Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
    2. Neurological Intervention & Imaging Service of Western Australia (NIISWA), Royal Perth Hospital, Perth, Western Australia, Australia
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  • David Blacker MBBS FRACP,

    1. Department of Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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  • Graeme J Hankey MBBS FRACP,

    1. Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
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  • William McAuliffe MBBS FRANZCR

    1. Neurological Intervention & Imaging Service of Western Australia (NIISWA), Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
    2. Neurological Intervention & Imaging Service of Western Australia (NIISWA), Royal Perth Hospital, Perth, Western Australia, Australia
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  • Conflict of interest: None declared.

Correspondence

Dr John Joseph McCabe, Brownstown, Kilcloon, Co., Meath, Ireland.

Email: mccabej1@tcd.ie

Abstract

Introduction

Mechanical thrombectomy has the potential to revolutionise the treatment of acute stroke. The Solitaire AB device is used for clot retrieval with unprecedented revascularisation rates being reported. Our aim is to report our experiences of the safety and efficacy of the Solitaire AB device in acute ischaemic stroke.

Methods

A retrospective dual-centre study of 21 patients with acute ischaemic stroke who underwent mechanical thrombectomy with the Solitaire AB device between 1 October 2010 and 1 December 2011 was carried out. Using clinical data recovered from patients' case notes, we identified time intervals from groin puncture to recanalisation, revascularisation rates, procedural complications and neurological status before and after treatment (using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) respectively).

Results

Successful revascularisation, defined as Thrombosis in Cerebral Ischemia Grade 2 or 3, was achieved in 81% of cases. The mean NIHSS score at presentation was 18.5. The mean number of passes required to achieve recanalisation was 1.95 and the median duration of the procedure from groin puncture to recanalisation was 65 min. Procedural events included distal emboli (n = 2), arterial dissection (n = 1) and arterial perforation (n = 1).There were three cases of asymptomatic intracranial haemorrhage. Forty-eight per cent of patients achieved a good functional outcome at 3 months (mRS score ≤2). The mortality rate at 3 months was 19% (n = 4). There was no procedure-related mortality.

Conclusions

Mechanical thrombectomy with the Solitaire AB device is safe and achieves high rates of revascularisation in acute stroke with good clinical outcomes.

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