Abstract
Purpose
Our purpose was to assess the efficacy and safety of the pRESET LITE stent retriever (Phenox, Bochum, Germany), designed for medium vessel occlusion (MeVO) in acute ischemic stroke (AIS) patients with a primary MeVO.
Methods
We performed a retrospective analysis of the MAD MT Consortium, an integration of prospectively maintained databases at 37 academic institutions in Europe, North America, and Asia, of AIS patients who underwent mechanical thrombectomy with the pRESET LITE stent retriever for a primary MeVO. We subcategorized occlusions into proximal MeVOs (segments A1, M2, and P1) vs. distal MeVOs/DMVO (segments A2, M3-M4, and P2). We reviewed patient and procedural characteristics, as well as angiographic and clinical outcomes.
Results
Between September 2016 and December 2021, 227 patients were included (50% female, median age 78 [65–84] years), of whom 161 (71%) suffered proximal MeVO and 66 (29%) distal MeVO. Using a combined approach in 96% of cases, successful reperfusion of the target vessel (mTICI 2b/2c/3) was attained in 85% of proximal MeVO and 97% of DMVO, with a median of 2 passes (IQR: 1–3) overall. Periprocedural complications rate was 7%. Control CT at day 1 post-MT revealed a hemorrhagic transformation in 63 (39%) patients with proximal MeVO and 24 (36%) patients with DMVO, with ECASS-PH type hemorrhagic transformations occurring in 3 (1%) patients. After 3 months, 58% of all MeVO and 63% of DMVO patients demonstrated a favorable outcome (mRS 0–2).
Conclusion
Mechanical thrombectomy using the pRESET LITE in a combined approach with an aspiration catheter appears effective for primary medium vessel occlusions across several centers and physicians.
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Data availability
The data supporting this study's findings are available from the corresponding author upon reasonable request. The results of this study are reported in accordance with the Strengthening the Reporting of Observational Cohort Studies in Epidemiology guidelines.
References
Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387(10029):1723–1731. https://doi.org/10.1016/s0140-6736(16)00163-x
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K et al (2019) Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 50(12):e344-418. https://doi.org/10.1161/str.0000000000000211
Saver JL, Chapot R, Agid R, Hassan A, Jadhav AP, Liebeskind DS et al (2020) Thrombectomy for distal, medium vessel occlusions: a consensus statement on present knowledge and promising directions. Stroke 51(9):2872–2884. https://doi.org/10.1161/strokeaha.120.028956
Sarraj A, Sangha N, Hussain MS, Wisco D, Vora N, Elijovich L et al (2016) Endovascular therapy for acute ischemic stroke with occlusion of the middle cerebral artery M2 segment. JAMA Neurol 73(11):1291–1296. https://doi.org/10.1001/jamaneurol.2016.2773
Rikhtegar R, Mosimann PJ, Weber R, Wallocha M, Yamac E, Mirza-Aghazadeh-Attari M et al (2021) Effectiveness of very low profile thrombectomy device in primary distal medium vessel occlusion, as rescue therapy after incomplete proximal recanalization or following iatrogenic thromboembolic events. J Neurointerv Surg 13(12):1067–1072. https://doi.org/10.1136/neurintsurg-2020-017035
Nguyen TN, Qureshi MM, Strambo D, Strbian D, Räty S, Herweh C et al (2023) Endovascular versus medical management of posterior cerebral artery occlusion stroke: the PLATO study. Stroke 54(7):1708–1717. https://doi.org/10.1161/strokeaha.123.042674
Meyer L, Stracke P, Broocks G, Elsharkawy M, Sporns P, Piechowiak EI et al (2023) Thrombectomy versus medical management for isolated anterior cerebral artery stroke: an international multicenter registry study. Radiology 307(2):e220229. https://doi.org/10.1148/radiol.220229
Dobrocky T, Bellwald S, Kurmann R, Piechowiak EI, Kaesmacher J, Mosimann PJ et al (2020) Stent retriever thrombectomy with mindframe capture LP in isolated M2 occlusions. Clin Neuroradiol 30(1):51–58. https://doi.org/10.1007/s00062-018-0739-4
Kühn AL, Wakhloo AK, Lozano JD, Massari F, De Macedo RK, Marosfoi MG et al (2017) Two-year single-center experience with the “Baby Trevo” stent retriever for mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg 9(6):541–546. https://doi.org/10.1136/neurintsurg-2016-012454
Hofmeister J, Kulcsar Z, Bernava G, Pellaton A, Yilmaz H, Erceg G et al (2018) The Catch Mini stent retriever for mechanical thrombectomy in distal intracranial occlusions. J Neuroradiol 45(5):305–309. https://doi.org/10.1016/j.neurad.2018.01.051
Ho FL, Chapot R (2020) Removal of distal fragments of liquid embolic agents during arteriovenous malformation embolization using the TIGERTRIEVER 13: a technical report. J Neurointerv Surg 12(8):794. https://doi.org/10.1136/neurintsurg-2019-015474
Goertz L, Weiss D, Abdullayev N, Moenninghoff C, Borggrefe J, Phung TH et al (2022) Safety and efficacy of the novel low-profile APERIO Hybrid17 for a treatment of proximal and distal vessel occlusion in acute ischemic stroke: a multi-center experience. World Neurosurg 167:e386–e396. https://doi.org/10.1016/j.wneu.2022.08.023
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K et al (2018) 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49(3):e46-110. https://doi.org/10.1161/str.0000000000000158
Alawieh AM, Chalhoub RM, Al Kasab S, Jabbour P, Psychogios MN, Starke RM et al (2023) Multicenter investigation of technical and clinical outcomes after thrombectomy for distal vessel occlusion by frontline technique. J Neurointerv Surg 15(e1):e93–e101. https://doi.org/10.1136/jnis-2022-019023
Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL et al (2013) Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke 44(9):2650–2663. https://doi.org/10.1161/strokeaha.113.001972
Maus V, Styczen H, Liman J, Maier I, Brehm A, Tsogkas I et al (2019) Intracranial mechanical thrombectomy of large vessel occlusions in the posterior circulation using SAVE. BMC Neurol 19(1):197. https://doi.org/10.1186/s12883-019-1428-x
Zaidat OO, Castonguay AC, Linfante I, Gupta R, Martin CO, Holloway WE et al (2018) First pass effect: a new measure for stroke thrombectomy devices. Stroke 49(3):660–666. https://doi.org/10.1161/strokeaha.117.020315
Kurre W, Aguilar-Pérez M, Martinez-Moreno R, Schmid E, Bäzner H, Henkes H (2017) Stent retriever thrombectomy of small caliber intracranial vessels using pREset LITE: safety and efficacy. Clin Neuroradiol 27(3):351–360. https://doi.org/10.1007/s00062-016-0497-0
Meyer L, Stracke P, Wallocha M, Broocks G, Sporns P, Piechowiak EI et al (2022) Aspiration versus stent retriever thrombectomy for distal, medium vessel occlusion stroke in the posterior circulation: a subanalysis of the TOPMOST study. Stroke 53(8):2449–2457. https://doi.org/10.1161/strokeaha.121.037792
Nikoubashman O, Wischer D, Hennemann HM, Büsen M, Brockmann C, Wiesmann M (2018) Under pressure: comparison of aspiration techniques for endovascular mechanical thrombectomy. AJNR Am J Neuroradiol 39(5):905–909. https://doi.org/10.3174/ajnr.a5605
Ahmed N, Wahlgren N, Grond M, Hennerici M, Lees KR, Mikulik R et al (2010) Implementation and outcome of thrombolysis with alteplase 3-4.5 h after an acute stroke: an updated analysis from SITS-ISTR. Lancet Neurol 9(9):866–74. https://doi.org/10.1016/s1474-4422(10)70165-4
Hong JM, Kim DS, Kim M (2021) Hemorrhagic transformation after ischemic stroke: mechanisms and management. Front Neurol 12:703258. https://doi.org/10.3389/fneur.2021.703258
Schönenberger S, Hendén PL, Simonsen CZ, Uhlmann L, Klose C, Pfaff JAR et al (2019) Association of general anesthesia vs procedural sedation with functional outcome among patients with acute ischemic stroke undergoing thrombectomy: a systematic review and meta-analysis. JAMA 322(13):1283–1293. https://doi.org/10.1001/jama.2019.11455
Cappellari M, Pracucci G, Forlivesi S, Saia V, Nappini S, Nencini P et al (2020) General anesthesia versus conscious sedation and local anesthesia during thrombectomy for acute ischemic stroke. Stroke 51(7):2036–2044. https://doi.org/10.1161/strokeaha.120.028963
Meyer L, Stracke CP, Broocks G, Wallocha M, Elsharkawy M, Sporns PB, et al (2023) Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery. J Neurointerv Surg jnis-2023–020210. https://doi.org/10.1136/jnis-2023-020210
Elhorany M, Rosso C, Shotar E, Baronnet-Chauvet F, Premat K, Lenck S et al (2022) Safety and effectiveness of mechanical thrombectomy for primary isolated distal vessel occlusions: a monocentric retrospective comparative study. J Neuroradiol 49(4):311–316. https://doi.org/10.1016/j.neurad.2022.03.008
Mokin M, Fargen KM, Primiani CT, Ren Z, Dumont TM, Brasiliense LBC et al (2017) Vessel perforation during stent retriever thrombectomy for acute ischemic stroke: technical details and clinical outcomes. J Neurointerv Surg 9(10):922–928. https://doi.org/10.1136/neurintsurg-2016-012707
Schwaiger BJ, Gersing AS, Zimmer C, Prothmann S (2015) The curved MCA: influence of vessel anatomy on recanalization results of mechanical thrombectomy after acute ischemic stroke. AJNR Am J Neuroradiol 36(5):971–976. https://doi.org/10.3174/ajnr.a4222
Rai AT, Hogg JP, Cline B, Hobbs G (2013) Cerebrovascular geometry in the anterior circulation: an analysis of diameter, length and the vessel taper. J Neurointerv Surg 5(4):371–375. https://doi.org/10.1136/neurintsurg-2012-010314
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Wang, M., Henkes, H., Ghozy, S. et al. Use of the pRESET LITE thrombectomy device in combined approach for medium vessel occlusions: A multicenter evaluation. Neuroradiology 66, 631–641 (2024). https://doi.org/10.1007/s00234-024-03302-5
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DOI: https://doi.org/10.1007/s00234-024-03302-5