SAN DIEGO – Stent retrievers were associated with higher rates of recanalization, shorter recanalization times, and better outcomes than multimodality recanalization strategies, based on a retrospective, single-center chart review of 60 acute stroke patients with a substantial proportion of carotid "T" occlusions.
The study, presented at the annual meeting of the American Society of Neuroradiology, included 23 patients treated primarily with stent retrievers (Solitaire AB neurovascular remodeling device) and 37 treated with other modalities.
The multimodality group received intra-arterial tissue plasminogen activator therapy (10), mechanical thromboaspiration (18), angioplasty (6), earlier-generation mechanical retriever devices (2), and stent only (1). The two groups were similar in age, gender, intravenous tissue plasminogen activator use (65% and 68%), and stroke risk factors.
Dr. Cheemun Lum
Terminal carotid "T" occlusions, which generally respond poorly to thrombolysis, were present in 12 of the 23 patients in the stent-retrieval group and in 12 of the 37 patients in the multimodality cohort, said Dr. Cheemun Lum, a neurointerventional radiologist at the Ottawa Hospital, University of Ottawa.
The stent-retriever group had higher recanalization rates than the multimodality group (87% vs. 51%, P = .005). There was no significant difference in median time to recanalization between groups (68 minutes vs. 79 minutes).
Mortality was eight-fold higher in the multimodality group than in the stent-retriever group (32% vs. 4%, P = .011). At 30-day follow-up, 61% of the stent retriever group had good outcomes, defined as a Modified Rankin Scale score of 2 or less. When the outcomes definition was expanded to include a 10-point reduction in score on the National Institutes of Health Stroke Scale, 78% of the stent-retriever group had good outcomes at 30 days, compared with 43% in the multimodality group (P = .008).
Restricting the analysis to patients with terminal carotid "T" occlusions, recanalization rates were higher in the stent-retriever group (83% vs. 38%, P = .012) and recanalization times were shorter (69 minutes vs. 191 minutes, P = .002). Three times as many patients with terminal carotid "T" occlusions in the stent-retriever group had good outcomes as did those undergoing older techniques (67% vs. 22%, P = .04).
Dr. Lum said that he had no financial disclosures.