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,, ,, The Solitaire AB (ev3 Inc, Plymouth, MN) is a self-expanding and fully retrievable stent that can be used as a thrombectomy device for large arterial occlusions. ,, , Accordingly, new thrombectomy devices have been developed to recanalize large vessel occlusions more successfully and more rapidly. ,, However, a large thrombus is quite resistant to a standard microcatheter thrombolysis technique and usually require a prolonged time for recanalization, which would fail to improve outcomes even after achieving recanalization. Several trials and a meta-analysis have indicated that IA fibrinolysis substantially increases recanalization rates and good and excellent clinical outcomes.
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Intra-arterial (IA) thrombolysis is a promising option for acute large arterial occlusions. If not treated with TPA, the chance of good outcome further decreased to 18%. , For severe strokes of NIHSS score ≥16, even after intravenous TPA, one third died, another one third remained severely disabled (modified Rankin Scale 4-5), and only one-fourth of patients were independent (mRS 0-2) at 3 months.
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With intravenous tissue plasminogen activator (tPA) therapy, the recanalization rate was only 10% in internal carotid artery (ICA) occlusion and less than 30% for proximal middle cerebral artery (M1 portion of MCA) occlusion.
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Available from: Īcute stroke due to a large vessel occlusion is a catastrophe, usually destined to death or severe disability. Safety and efficacy of mechanical thrombectomy with the Solitaire device in large artery occlusion.
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How to cite this URL: Kim JE, Kim AR, Paek YM, Cho YJ, Lee BH, Hong KS. How to cite this article: Kim JE, Kim AR, Paek YM, Cho YJ, Lee BH, Hong KS. Keywords: Stent, stroke, thrombectomy, thrombolysis Conclusions: Mechanical thrombectomy with the Solitaire device can effectively recanalize proximal large vessel occlusions, and potentially improves clinical outcome. There was no procedure-related complication. SHT occurred in two patients (20%), and 3-month mortality rate was 30%. Four (40%) patients had a good functional outcome at 3 months, and three (30%) patients had an early substantial neurological improvement. Successful recanalization was achieved in 7 (70%) patients. Six patients received intravenous TPA before intra-arterial treatment, and five patients were treated with adjuvant intra-arterial urokinase. Results: Ten patients were consecutively enrolled: Age: 72.4 5.7 years female: 70% baseline median NIHSS score: 19.5 and ICA occlusion in 50% and M1 portion of MCA occlusion in 50%. Secondary outcomes were good functional outcome at 3 months (modified Rankin Scale ≤2), early substantial neurological improvement (NIHSS score improvement ≥8 at 24 hours), and symptomatic hemorrhagic transformation (SHT). The primary outcome was recanalization defined as Thrombolysis in Cerebral Infarct (TICI) reperfusion grade 2b/3. Inclusion criteria were severe stroke of National Institutes of Health Stroke Scale (NIHSS) score ≥10, treatment initiation within 6 hours from onset, and an angiographically verified occlusion of proximal middle cerebral artery (MCA) or internal carotid artery (ICA). Materials and Methods: This is a single center study enrolling patients treated with Solitaire-assisted thrombectomy between November 2010 and March 2011. This study was to assess the safety and efficacy of mechanical thrombectomy with a retrievable Solitaire stent in acute large artery occlusions. Background and Purpose: Intravenous tissue plasminogen activator (TPA) has limited efficacy in proximal large vessel occlusions.