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57 yo female, NIHSS 22, IV rTPA with no clinical effect

The Potential of Stent-Trievers: Experience in 108 Acute Ischemic Stroke Treatments T. Liebig, H. Lockau, S. Stehle, D. Dorn, S. Prothmann, A. Foerschler, H. Henkes Klinikum Rechts der Isar, TU Mȕnchen. 57 yo female, NIHSS 22, IV rTPA with no clinical effect. LIF and phenox CRC 2/4/22.

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57 yo female, NIHSS 22, IV rTPA with no clinical effect

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  1. The Potential of Stent-Trievers: Experience in 108 Acute Ischemic Stroke TreatmentsT. Liebig, H. Lockau, S. Stehle, D. Dorn, S. Prothmann, A. Foerschler,H. HenkesKlinikum Rechts der Isar, TU Mȕnchen

  2. 57 yo female, NIHSS 22, IV rTPA with no clinical effect

  3. LIF andphenox CRC 2/4/22

  4. LIF with unfolded Stent: Solitaire in sup. trunc

  5. ...followed by deployment in inferior trunc...

  6. after 30 minutes (20mg rTPA) Concept of temporary bypass

  7. no LIF, straight MTE

  8. delivery and retrieval

  9. Solitaire FR re-establishes flow enhances lysis fragmentation MTE (potential implant, AB)

  10. TU Munich 03/2008 – 12/2009 • 104 Pat. with 108 Occlusions • NIHSS pre 15.3 • Solitaire only n=25 • Multimodal n=83 • most frequent: Solitaire and large caliber cath for repeat access and aspiration (42x Penumbra, 20x Concentric DAC) • 15/108 as temporary bypass (in the beginning) • success vs failure in MTE cases: 83/10 • number of passages: 2.46 (median 2, maximal: 12)

  11. Why Solitaire + DAC ? • 57 yo female, NIHSS 14 • right M1 occlusion • 3h from onset and after full IV lysis

  12. Standard proximal M1-occlusion

  13. standard access ?

  14. 6F Envoy XB, 035-Terumo GW and 4.4 DAC 115cm

  15. SynchroandProwler Select plus via a DAC

  16. Solitaire 6/30 anchored in MCA in order to straighten the ICA

  17. Results: Outcome (at hospital Dx) • NIHSS reduced 7.8 mean • mRS 0-2 total: 25.6% • anterior circ. only: 30% • mortality: • 13/84 anterior circulation • 11/24 VA-BA-territory

  18. Procedural Data - Solitaire • Onset to reperfusion: 56-1031 mean 265 minutes, median 230 minutes • 58/104 pts. in combination with IV-Lysis • 32/104 pts. LIF and MTE Distribution

  19. Reperfusion TIMI II/III: 92.5% 72.8% TIMI II/III at or after 1. Application (!)

  20. Solitaire vs. non-Solitaire 20% MORE TICI 2b/3 compared to non-Solitaire cases Chi-Quadrat and Fishers exact test: p = 0.000

  21. ART: mean 47min. (5-186), median 38.5min P-value of Mann-Whitney-U-Test: p = 0,021

  22. Adverse events (procedural) • 1 fatal: Ruptureofinsertionwirewithpossibleperforationatthe proximal tip: no SAH/ICH initially but 4h post proc. underGP IIb/IIIa • 1 Stent not applicablethroughmc • 1 SAH immediately after stent placement • 5 morepatientswithevidenceofhemorrhageat F/U CT but not attributableto Solitaire • 4 earlycasesofclotmigration, todayavoidedbyDAC use

  23. Summary • effektive: 80% TICI 2b/3 • safe: 1/108 serious Solitaire related adverse event • fast: significantly shorter DSA to reperfusion time • versatile !!!

  24. Solitaire: Stent or Retriever ?

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