Rescue, Combined, and Stand-Alone Thrombectomy in the Management of Large Vessel Occlusion Stroke Using the Solitaire Device: A Prospective 50-Patient Single-Center Study
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- Vincent Costalat
- From the CHU Montpellier Neuroradiology (V.C., P.M., K.L., I.M., J.F.V., C.R., A.B.), Montpellier, France; CHU Montpellier Neurology (I.M., D.M., C.H., C.A.), Montpellier, France; CHU Montpellier (P.F.P.), SARC, Ansesthesiology, Montpellier, France.
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- Paolo Machi
- From the CHU Montpellier Neuroradiology (V.C., P.M., K.L., I.M., J.F.V., C.R., A.B.), Montpellier, France; CHU Montpellier Neurology (I.M., D.M., C.H., C.A.), Montpellier, France; CHU Montpellier (P.F.P.), SARC, Ansesthesiology, Montpellier, France.
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- Kyriakos Lobotesis
- From the CHU Montpellier Neuroradiology (V.C., P.M., K.L., I.M., J.F.V., C.R., A.B.), Montpellier, France; CHU Montpellier Neurology (I.M., D.M., C.H., C.A.), Montpellier, France; CHU Montpellier (P.F.P.), SARC, Ansesthesiology, Montpellier, France.
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- Igor Maldonado
- From the CHU Montpellier Neuroradiology (V.C., P.M., K.L., I.M., J.F.V., C.R., A.B.), Montpellier, France; CHU Montpellier Neurology (I.M., D.M., C.H., C.A.), Montpellier, France; CHU Montpellier (P.F.P.), SARC, Ansesthesiology, Montpellier, France.
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- Jean François Vendrell
- From the CHU Montpellier Neuroradiology (V.C., P.M., K.L., I.M., J.F.V., C.R., A.B.), Montpellier, France; CHU Montpellier Neurology (I.M., D.M., C.H., C.A.), Montpellier, France; CHU Montpellier (P.F.P.), SARC, Ansesthesiology, Montpellier, France.
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- Carlos Riquelme
- From the CHU Montpellier Neuroradiology (V.C., P.M., K.L., I.M., J.F.V., C.R., A.B.), Montpellier, France; CHU Montpellier Neurology (I.M., D.M., C.H., C.A.), Montpellier, France; CHU Montpellier (P.F.P.), SARC, Ansesthesiology, Montpellier, France.
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- Isabelle Mourand
- From the CHU Montpellier Neuroradiology (V.C., P.M., K.L., I.M., J.F.V., C.R., A.B.), Montpellier, France; CHU Montpellier Neurology (I.M., D.M., C.H., C.A.), Montpellier, France; CHU Montpellier (P.F.P.), SARC, Ansesthesiology, Montpellier, France.
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- Didier Milhaud
- From the CHU Montpellier Neuroradiology (V.C., P.M., K.L., I.M., J.F.V., C.R., A.B.), Montpellier, France; CHU Montpellier Neurology (I.M., D.M., C.H., C.A.), Montpellier, France; CHU Montpellier (P.F.P.), SARC, Ansesthesiology, Montpellier, France.
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- Chérif Héroum
- From the CHU Montpellier Neuroradiology (V.C., P.M., K.L., I.M., J.F.V., C.R., A.B.), Montpellier, France; CHU Montpellier Neurology (I.M., D.M., C.H., C.A.), Montpellier, France; CHU Montpellier (P.F.P.), SARC, Ansesthesiology, Montpellier, France.
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- Pierre-François Perrigault
- From the CHU Montpellier Neuroradiology (V.C., P.M., K.L., I.M., J.F.V., C.R., A.B.), Montpellier, France; CHU Montpellier Neurology (I.M., D.M., C.H., C.A.), Montpellier, France; CHU Montpellier (P.F.P.), SARC, Ansesthesiology, Montpellier, France.
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- Caroline Arquizan
- From the CHU Montpellier Neuroradiology (V.C., P.M., K.L., I.M., J.F.V., C.R., A.B.), Montpellier, France; CHU Montpellier Neurology (I.M., D.M., C.H., C.A.), Montpellier, France; CHU Montpellier (P.F.P.), SARC, Ansesthesiology, Montpellier, France.
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- Alain Bonafé
- From the CHU Montpellier Neuroradiology (V.C., P.M., K.L., I.M., J.F.V., C.R., A.B.), Montpellier, France; CHU Montpellier Neurology (I.M., D.M., C.H., C.A.), Montpellier, France; CHU Montpellier (P.F.P.), SARC, Ansesthesiology, Montpellier, France.
書誌事項
- タイトル別名
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- Timing, Safety, and Efficacy
説明
<jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>Large vessel occlusion in ischemic stroke is associated with a high degree of morbidity. When intravenous thrombolysis fails, mechanical thrombectomy can provide an alternative and synergistic method for flow restoration. In this study we evaluate the safety and efficacy of our stroke management protocol (RECOST study).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>Fifty consecutive ischemic stroke patients with large vessel occlusion were included. After clinical and MRI imaging assessment, 3 treatment strategies were selected according to time of symptom onset and location of vessel occlusion: rescue therapy; combined therapy; and stand-alone thrombectomy (RECOST study). MRI ASPECT score <5 was the main exclusion criterion. Mechanical thrombectomy was performed exclusively with the Solitaire flow restoration device. Clinical outcome was assessed after treatment, on day 1, and at discharge.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p>Mean patient age was 67.6 years, mean NIHSS score was 14.7, and mean ASPECT score was 6 on presentation. Vessel occlusions were in the middle cerebral artery (40%), the internal carotid artery (28%), and the basilar artery (32%). Rescue treatment represented 24%, combined therapy represented 56%, and stand-alone thrombectomy represented 20%. Mean recanalization time from symptoms onset was 377 minutes, with overall recanalization rate TICI 3 of 84%. NIHSS score at discharge was 6.5, with 60% of patients demonstrating NIHSS score 0 to 1 or an improvement of >9 points. Symptomatic complication rate was 10%. At 3 months, 54% of patients had a modififed Rankin scale score of 0 to 2, with an overall mortality rate of 12%.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>The present integrated stroke management protocol (RECOST study) demonstrated rapid, safe, and effective recanalization. We postulate that the Solitaire device contributed to high recanalization and patient selection using MRI ASPECT score to low and complication rates, therefore avoiding futile and dangerous interventions.</jats:p> </jats:sec>
収録刊行物
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- Stroke
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Stroke 42 (7), 1929-1935, 2011-07
Ovid Technologies (Wolters Kluwer Health)