Trombectomía Mecánica: Nuevos avances
El departamento de neurociencias del hospital Germans Trias i Pujol publica en la revista Stroke los resultados de un estudio Piloto realizado sobre 20 pacientes con oculisón en grandes arterias de la circulación anterior con un nuevo dispositivo para la realización de una trombectomía mecánica, que permite ampliar la ventana terapeútica pata el intervencionismo en el ictus agudo, y, además tratar oclusiones d egrandes arterias cerebrales donde la eficacia de la trombolisis por via arterial es menor.
Stroke. 2010 Jun 10. [Epub ahead of print]
Mechanical Thrombectomy With the Solitaire AB Device in Large Artery Occlusions of the Anterior Circulation. A Pilot Study.
Castaño C, Dorado L, Guerrero C, Millán M, Gomis M, Perez de la Ossa N, Castellanos M, García MR, Domenech S, Dávalos A.
From Unit of Interventional Neuroradiology and Acute Stroke Unit, Service of Neurology, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain; Acute Stroke Unit, Service of Neurology, Hospital Doctor Josep Trueta, Girona, Spain; Institut de Diagnostic per la Imatge, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
Abstract
BACKGROUND AND PURPOSE: To describe the safety and effectiveness of a self-expanding and fully retrievable stent (Solitaire AB; ev3 Inc, Plymouth, MN) in revascularization of patients with acute ischemic stroke. METHODS: Prospective, single-center study of 20 patients with an acute ischemic stroke attributable to a large artery occlusion of the anterior circulation within the first 8 hours from symptoms onset (median National Institutes of Health Stroke Scale, 19 [interquartile range, 15-23]). The occlusion site was middle cerebral artery in 12 patients, proximal internal carotid artery/middle cerebral artery tandem occlusion in 3 patients, and terminus internal carotid artery in 5 patients. Thrombectomy was used as rescue therapy in 2 patients who were refractory to intra-arterial plasminogen activator, and in 3 patients in whom successful recanalization with the MERCI retriever was not achieved. RESULTS: Successful revascularization defined as thrombosis in cerebral ischemia grade 2b or 3 was achieved in 18 of 20 (90%) treated vessels, and 16 patients showed immediate restoration of flow after stent deployment. The mean number of passes for maximal recanalization was 1.4, and the median (quartiles) time from groin puncture to recanalization was 50 (38-71) minutes. No case required adjuvant therapy after deployment of the embolectomy device. No significant procedural events occurred. Symptomatic intracranial hemorrhage was found in 2 (10%) patients, 4 (20%) patients died during the 90-day follow-up period, and 45% of patients showed good functional outcome at 3 months (modified Rankin Scale score </=2). CONCLUSIONS: These results suggest that the Solitaire AB device can rapidly, safely, and effectively retrieve clots from the middle cerebral artery and terminus internal carotid artery within 8 hours from symptoms onset.