J Korean Neurosurg Soc.  2015 May;57(5):342-349. 10.3340/jkns.2015.57.5.342.

Comparative Analysis of Endovascular Stroke Therapy Using Urokinase, Penumbra System and Retrievable (Solitare) Stent

• Choi JH
• Park HS
• Kim DH
• Cha JK
• Huh JT
• Kang M

• KMID: 1881731
• DOI: http://doi.org/10.3340/jkns.2015.57.5.342

Abstract

BACKGROUND
Higher reperfusion rates have been established with endovascular treatment for acute ischemic stroke patients. There are limited data on the comparative performance of mechanical thrombectomy devices. This study aimed to analyse the efficacy and safety of the stent retriever device (Solitaire stent) by comparing procedure time, angiographic outcome, complication rate and long term clinical outcome with previous chemical thrombolysis and mechanical thrombectomy using penumbra system.
METHODS
A retrospective single-center analysis was undertaken of all consecutive patients who underwent chemical thrombolysis and mechanical thrombectomy using Penumbra or Solitaire stent retriever from March 2009 to March 2014. Baseline characteristics, rate of successful recanalization (modified Thrombolysis in Cerebral Infarction score 2b-3), symptomatic intracerebral hemorrhage, procedure time, mortality and independent functional outcomes (mRS < or =2) at 3 month were compared across the three method.
RESULTS
Our cohort included 164 patients, mechanical thrombectomy using stent retriever device had a significant impact on recanalization rate and functional independence at 3 months. In unadjusted analysis mechanical thrombectomy using Solitaire stent retriever showed higher recanalization rate than Penumbra system and chemical thrombolysis (75% vs. 64.2% vs. 49.4%, p=0.03) and higher rate of functional independence at 3 month (53.1% vs. 37.7% vs. 35.4%, p=0.213). In view of the interrelationships between all predictors of variables associated with a good clinical outcome, when the chemical thrombolysis was used as a reference, in multiple logistic regression analysis, the use of Solitaire stent retriever showed higher odds of independent functional outcome [odds ratio (OR) 2.62, 95% confidence interval (CI) 0.96-7.17; p=0.061] in comparison with penumbra system (OR 1.57, 95% CI 0.63-3.90; p=0.331).
CONCLUSION
Our initial data suggest that mechanical thrombectomy using stent retriever is superior to the mechanical thrombectomy using penumbra system and conventional chemical thrombolysis in achieving higher rates of reperfusion and better outcomes. Randomized clinical trials are needed to establish the actual benefit to specific patient populations.

Keyword

Acute ischemic stroke; Thrombectomy; Thrombolysis

MeSH Terms

Cerebral Hemorrhage
Cerebral Infarction
Cohort Studies
Humans
Logistic Models
Mortality
Reperfusion
Retrospective Studies
Stents*
Stroke*
Thrombectomy
Urokinase-Type Plasminogen Activator*
Urokinase-Type Plasminogen Activator

Figure

• 

  Fig. 1 A : Pretreatment angiography shows complete occlusion of the M1 segment of the left MCA. B : A Penumbra 041 reperfusion catheter was approached proximal to the thrombus, and aspiration thrombectomy maneuver was performed. C : Immediate postprocedural angiography shows complete (TICI 3) revascularization. D : Photograph shows that whole clot retrieved from the occlusion of the left MCA. TICI : Thrombolysis In Cerebral Ischemia, MCA : middle cerebral artery.

• 

  Fig. 2 A : Pretreatment angiography shows complete occlusion of the M1 segment of the right MCA. B : Digital subtraction angiogram after deployment of the stent shows reopening of the vessel. C : After stent withdrawal, the vessel is fully recanalized. D : Photograph of gross analysis of the Solitaire device (ev3, Irvine, CA, USA) showing clot fragments within the stent retrieval system. MCA : middle cerebral artery.

• 

  Fig. 3 Distribution of the modified Rankin Score at 3 months in the Solitaire stent retriever, Penumbra thromboaspiration system and intra-arterial chemical thrombolysis groups. The percentage of patients is shown in each cell.

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