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2023-01-10

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cc-by-nc (c) Li Jiahui et al., 2023
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/221262

Double stent-retriever as the first-line approach in mechanical thrombectomy: a randomized in vitro evaluation

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Recurs relacionat

https://doi.org/10.1136/jnis-2022-019887

Resum

Background A repeated number of passes during mechanical thrombectomy leads to worse clinical outcomes in acute ischemic stroke. Initial experiences with the simultaneous double stent-retriever (double-SR) technique as the first-line treatment showed promising safety and efficacy results. Objective To characterize the potential benefits of using the double-SR as first-line technique as compared with the traditional single-SR approach. Methods Three types of clot analogs (soft, moderately stiff, and stiff) were used to create terminal internal carotid artery (T-ICA=44) and middle cerebral artery (MCA=88) occlusions in an in vitro neurovascular model. Sixty-six cases were randomized into each treatment arm: single-SR or double-SR, in combination with a 0.071" distal aspiration catheter. A total of 132 in vitro thrombectomies were performed. Primary endpoints were the rate of first-pass recanalization (%FPR) and procedural-related distal emboli. Results FPR was achieved in 42% of the cases. Overall, double-SR achieved a significantly higher %FPR than single-SR (52% vs 33%, P=0.035). Both techniques showed similar %FPR in T-ICA occlusions (single vs double: 23% vs 27%, P=0.728). Double-SR significantly outperformed single-SR in MCA occlusions (63% vs 38%, P=0.019), most notably in saddle occlusions (64% vs 14%, P=0.011), although no significant differences were found in single-branch occlusions (64% vs 50%, P=0.275). Double-SR reduced the maximal size of the clot fragments migrating distally (Feret diameter=1.08±0.65 mm vs 2.05±1.14 mm, P=0.038). Conclusions This randomized in vitro evaluation demonstrates that the front-line double-SR technique is more effective than single-SR in achieving FPR when treating MCA bifurcation occlusions that present saddle thrombus.

Matèries

Trombosi, Malalties cerebrovasculars, Catèters

Matèries (anglès)

Thrombosis, Cerebrovascular disease, Catheters

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Col·leccions

Articles publicats en revistes (Enginyeria Electrònica i Biomèdica)

Citació

LI, Jiahui, TIBERI, Riccardo, CANALS, Pere, VARGAS, Daniel, CASTAÑO LINARES, Óscar, MOLINA, Marc, TOMASELLO, Alejandro, RIBÓ JACOBI, Marc. Double stent-retriever as the first-line approach in mechanical thrombectomy: a randomized in vitro evaluation. _Journal of Neurointerventional Surgery_. 2023. [consulta: 27 de gener de 2026]. ISSN: 1759-8478. [Disponible a: https://hdl.handle.net/2445/221262]

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