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Stroke. 2013 Dec;44(12):3577-9. doi: 10.1161/STROKEAHA.113.002673. Epub 2013 Sep 10.

Switching strategy for mechanical thrombectomy of acute large vessel occlusion in the anterior circulation.

Author information

1
From the Department of Radiology (D.-H.K., Y.-W.K., Y.-S.K.), Department of Neurology (Y.-W.K., Y.-H.H.), and Department of Neurosurgery (D.-H.K., J.P., J.-H.H.), Kyungpook National University Hospital, Daegu, Republic of Korea.

Abstract

BACKGROUND AND PURPOSE:

We introduce the concept of a switching strategy for mechanical thrombectomy with period-to-period analysis. In period 1, forced arterial suction thrombectomy with a Penumbra reperfusion catheter was performed, even in difficult cases; in period 2, forced arterial suction thrombectomy was initially performed, with switching to Solitaire in difficult cases.

METHODS:

We analyzed 135 consecutive patients treated with mechanical thrombectomy with acute large vessel occlusion in the anterior circulation, 61 from period 1 and 74 from period 2. We defined difficult case for both periods as ≥3 failed attempts at recanalization.

RESULTS:

Period 2 showed a trend for better angiographic outcome of Thrombolysis in Cerebral Infarction 2b-3 (73.8%, period 1 versus 85.1%, period 2; P=0.10). In interperiod subgroup analysis of difficult cases, switching significantly outperformed nonswitching in Thrombolysis in Cerebral Infarction 2b-3 recanalization (52.7% versus 82.9%; P=0.030). Differences in puncture-to-recanalization time, symptomatic intracranial hemorrhage incidence, and procedure-related complications were not statistically significant.

CONCLUSIONS:

A switching strategy using 2 mechanical thrombectomy techniques (forced arterial suction thrombectomy to Solitaire) may harbor better angiographic outcomes than a 1 technique only strategy (forced arterial suction thrombectomy).

KEYWORDS:

acute stroke; mechanical thrombectomy; switching strategy

PMID:
24021683
DOI:
10.1161/STROKEAHA.113.002673
[Indexed for MEDLINE]

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