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2015 ; 57
(5
): 342-9
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Comparative Analysis of Endovascular Stroke Therapy Using Urokinase, Penumbra
System and Retrievable (Solitare) Stent
#MMPMID26113961
Choi JH
; Park HS
; Kim DH
; Cha JK
; Huh JT
; Kang M
J Korean Neurosurg Soc
2015[May]; 57
(5
): 342-9
PMID26113961
show ga
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 ?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.