Role of Solitaire in endovascular treatment for acute seriour stroke due to intracranial in situ thrombosis

Abstract

Background: Solitaire, a representative stent retriever, shows high performance in removing embolic clots however, its reperfusion potential in intracranial atherosclerotic disease (ICAD)-related occlusions is rarely reported. In this ROSE ASSIST study, we hypothesized that Solitaire is as effective for removing in-situ thrombi in ICAD-related occlusions as much as its performance in cardiogenic or cryptogenic embolism.

Methods: ASIAN KR, an observational multicenter registry (n=721) enrolling patients who underwent endovascular treatment for acute cervicocephalic artery occlusions, was retrospectively reviewed. Through blinded evaluations, ICAD-related (significant fixed focal stenosis observed at the occlusion site during endovascular treatment) and embolic (no or minimal stenosis observed) occlusions were classified. Among patients treated with Solitaire stent (n=373), exclusion criteria were as follows: onset to puncture time >720 min occlusion etiology neither ICAD-related nor embolic both ICAD-related occlusion and atrial fibrillation. Primary endpoint was successful reperfusion (modified Treatment In Cerebral Ischemia 2b-3) immediately after Solitaire stent retrieval. Comparative analyses were performed between embolic and ICAD-related occlusions (2:1 matched by propensity score age, sex, onset to puncture time and primary endovascular method adjusted).

Results: In total, 270 patients (embolic, 216 ICAD-related, 54) were included in the analyses. After propensity score matching, successful reperfusion rate following Solitaire stent treatment did not differ between etiologic groups (embolic, 77.8% vs. 68.5%, p=0.201). Although final successful reperfusion grade was similarly achieved between groups (83.3% vs. 75.9%, p=0.259), median number of endovascular methods was higher in ICAD-related occlusions (2 [interquartile range, 1-2] vs. 2 [2-3], p<0.001). The grade and frequency of intracerebral hemorrhagic transformation and subarachnoid hemorrhage did not differ between groups.

Conclusions: The immediate reperfusion performance of Solitaire for ICAD-related occlusions was as substantial as for embolic occlusions although these occlusions more often needed other treatment methods.