Highlights
- •CBT can decrease M2 stretching when an SR is distally deployed and retrieved.
- •Distal SR deployment without an AC enhances M2 vessel stretching.
- •Modifying vessel stretching may contribute to reduced PTSAH after EVT using an SR.
Abstract
Objectives
Post-thrombectomy subarachnoid hemorrhage, which is caused by vessel stretching when
retrieving a stent retriever (SR), is a complication of endovascular mechanical thrombectomy
(EVT) using an SR. This in vitro study examined the association between EVT for middle
cerebral artery (MCA) occlusion and M2 vessel stretching depending on the positioning
of the SR or combined use of SR and aspiration catheter (AC) technique (CBT).
Materials and methods
A silicone vascular model was used. The maximum migration distance (MMD) in the anteroposterior
view of an X-ray impermeable metal marker located at an M2 trunk 20 mm distal to the
M1-2 bifurcation in angiographic images during an SR retrieval was calculated. According
to the positioning of SR deployment (distal or proximal) and use of an AC [SR alone
without an AC (SR alone) group, stent retrieval into an AC (SA) group, and stent-AC
retrieval as a unit into a guiding catheter (SA unit) group], 60 attempts were conducted
with each group of 10 attempts.
Results
In distal SR deployment, the MMD in the CBT group, consisting of SA and SA unit groups,
was significantly smaller than the SR alone group (1.36 ± 0.32 mm VS 2.39 ± 1.10 mm;
p = 0.001). In proximal SR deployment, the CBT group showed a tendency to decrease
MMD (1.38 ± 0.33 mm VS 1.63 ± 0.28 mm; p = 0.077).
Conclusions
This in vitro study showed that CBT might help modify the stretching of M2 when an SR is distally
deployed in MCA occlusion.
Key Words
Abbreviation:
AC (aspiration catheter), ADAPT (a direct aspiration first-pass technique), AIS (acute ischemic stroke), A-P (anteroposterior), ASAP (a stent-retrieving into an aspiration catheter with proximal balloon), BGC (balloon guiding catheter), CAPTIVE (continuous aspiration prior to intracranial vascular embolectomy), CBT (combined use of a stent retriever and aspiration catheter technique), EVT (endovascular mechanical thrombectomy), FPE (first-pass effect), ICA (internal carotid artery), MCA (middle cerebral artery), MMD (maximum migration distance), mTICI (modified Thrombolysis In Cerebral Infarction), PTSAH (post-thrombectomy subarachnoid hemorrhage), SA (stent-retrieving into an aspiration catheter), SA unit (stent-aspiration catheter retrieving as a unit into a guiding catheter), SR (stent retriever), SR alone (stent retriever alone without an aspiration catheter)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Stent retriever thrombectomy for acute ischemic stroke: A systematic review and meta-analysis of randomized controlled trials, including THRACE.Rev Neurol (Paris). 2018; 174: 319-326
- A randomized trial of intraarterial treatment for acute ischemic stroke.N Engl J Med. 2015; 372: 11-20
- Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial.Lancet. 2012; 380 (London, England): 1231-1240
- Endovascular vs medical management of acute ischemic stroke.Neurology. 2015; 85: 1980-1990
- Stent retrievers in acute ischemic stroke: complications and failures during the perioperative period.AJNR Am J Neuroradiol. 2014; 35: 734-740
- Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial.Lancet Neurol. 2016; 15: 1138-1147
- Complications of endovascular treatment for acute ischemic stroke: prevention and management.Int J Stroke Off J Int Stroke Soc. 2018; 13: 348-361
- Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials.Lancet. 2016; 387 (London, England): 1723-1731
- Endovascular therapy for ischemic stroke with perfusion-imaging selection.N Engl J Med. 2015; 372: 1009-1018
- Long-term magnetic resonance angiography follow-up for recanalized vessels after mechanical thrombectomy.J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2014; 23: 2834-2839
- Randomized assessment of rapid endovascular treatment of ischemic stroke.N Engl J Med. 2015; 372: 1019-1030
- Thrombectomy within 8 hours after symptom onset in ischemic stroke.N Engl J Med. 2015; 372: 2296-2306
- Time to redefine success? TICI 3 versus TICI 2b recanalization in middle cerebral artery occlusion treated with thrombectomy.J Neurointerventional Surg. 2017; 9: 117-121
- Stroke thrombectomy complication management.J Neurointerventional Surg. 2021; 13: 912-917
- Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke.N Engl J Med. 2015; 372: 2285-2295
- A comparison of acute vascular damage caused by ADAPT versus a stent retriever device after thrombectomy in acute ischemic stroke: a histological and ultrastructural study in an animal model.J Neurointerventional Surg. 2017; 9: 743-749
- Experimental evaluation of stent retrievers' mechanical properties and effectiveness.J Neurointerventional Surg. 2017; 9: 257-263
- Comparison of subacute vascular damage caused by ADAPT versus stent retriever devices after thrombectomy in acute ischemic stroke: histological and ultrastructural study in an animal model.Interv Neurol. 2018; 7: 501-512
- Stent retriever thrombectomy of small caliber intracranial vessels using pREset LITE: safety and efficacy.Clin Neuroradiol. 2017; 27: 351-360
- Relationship between hemorrhagic complications and target vessels in acute thrombectomy.J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2017; 26: 1732-1738
- Subarachnoid hemorrhage in a multimodal approach heavily weighted toward mechanical thrombectomy with solitaire stent in acute stroke.Stroke. 2013; 44: 414-419
- Endovascular treatment of acute intracerebral artery occlusions with the solitaire stent: single-centre experience with 108 recanalization procedures.Cerebrovasc Dis. 2012; 34: 70-77
- Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients.J Neurointerventional Surg. 2018; 10: i27-i32
- Intraprocedural predictors of post-stent retriever thrombectomy subarachnoid hemorrhage in middle cerebral artery stroke.J Neurointerventional Surg. 2019; 11: 127-132
- Hemorrhage/contrast staining areas after mechanical intra-arterial thrombectomy in acute ischemic stroke: imaging findings and clinical significance.AJNR Am J Neuroradiol. 2012; 33: 1791-1796
- A stent-retrieving into an aspiration catheter with proximal balloon (ASAP) technique: a technique of mechanical thrombectomy.World Neurosurg. 2018; 109: e468-e475
- Predictors of intracranial hemorrhage in acute ischemic stroke after endovascular thrombectomy.Interv Neuroradiol J Peritherapeutic Neuroradiol Surg Proced Relat Neurosci. 2020; 26: 368-375
- Increased rate of successful first passage recanalization during mechanical thrombectomy for M2 occlusion.World Neurosurg. 2020; 139: e792-e799
- The curved MCA: influence of vessel anatomy on recanalization results of mechanical thrombectomy after acute ischemic stroke.AJNR Am J Neuroradiol. 2015; 36: 971-976
- A meta-analysis of combined aspiration catheter and stent retriever versus stent retriever alone for large-vessel occlusion ischemic stroke.AJNR Am J Neuroradiol. 2022; 43: 568-574
- Combined balloon guide catheter, aspiration catheter, and stent retriever technique versus balloon guide catheter and stent retriever alone technique: a systematic review and meta-analysis.J Neurointerventional Surg. 2022;
- Experimental evaluation of the risk of distal embolization during endovascular clot retrieval using various techniques.Asian J Neurosurg. 2021; 16: 84-88
- Longer 6-mm diameter stent retrievers are effective for achieving higher first pass success with fibrin-rich clots.Interv Neurol. 2020; 8: 187-195
- Mechanical thrombectomy in acute ischemic stroke: a meta-analysis of stent retrievers vs direct aspiration vs a combined approach.Neurosurgery. 2020; 86: 464-477
- Efficacy of combined use of a stent retriever and aspiration catheter in mechanical thrombectomy for acute ischemic stroke.J Neurointerventional Surg. 2021;
- Continuous aspiration prior to intracranial vascular embolectomy (CAPTIVE): a technique which improves outcomes.J Neurointerventional Surg. 2017; 9: 1154-1159
- Tri-axial system using the Solitaire-FR and penumbra aspiration microcatheter for acute mechanical thrombectomy.J Clin Neurosci Off J Neurosurg Soc Aust. 2013; 20: 1303-1305
- Endovascular therapy for acute ischemic stroke with occlusion of the middle cerebral artery M2 segment.JAMA Neurol. 2016; 73: 1291-1296
- A review of endovascular treatment for medium vessel occlusion stroke.J Neurointerventional Surgery. 2021; 13: 623-630
- Effect of distal access catheter tip position on angiographic and clinical outcomes following thrombectomy using the combined stent-retriever and aspiration approach.PLoS One. 2021; 16e0252641
Article info
Publication history
Published online: January 10, 2023
Accepted:
December 11,
2022
Received in revised form:
December 5,
2022
Received:
September 27,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106948
Copyright
© 2022 Elsevier Inc. All rights reserved.
