Mechanical thrombectomy with snare in patients with acute ischemic stroke.
BACKGROUND
We evaluated the efficacy and safety of thrombus extraction using a microsnare in patients with acute ischemic stroke (AIS).


METHODS
This was a prospective, observational, cohort study in which consecutive patients with AIS (<6 hours of ischemia for anterior circulation and <24 hours for posterior circulation) who had been previously excluded from intravenous tissue plasminogen activator (tPA) thrombolysis were included and followed-up for 3 months. Mechanical embolectomy with a microsnare of 2-4 mm was undertaken as the first treatment. Low-dose intraarterial thrombolysis or angioplasty was used if needed. TIMI grade and modified Rankin stroke scale (mRSS) score were used to evaluate vessel recanalization and clinical efficacy, respectively.


RESULTS
Nine patients (mean age 55 years, range 17-69 years) were included. Their basal mean NIHSS score was 16 (range 12-24). In seven out of the nine patients (77.8%) the clot was removed, giving a TIMI grade of 3 in four patients and TIMI grade 2 in three patients. Occlusion sites were: middle cerebral artery (four), basilar artery (two) and anterior cerebral artery plus middle cerebral artery (one). The mean time for recanalization from the start of the procedure was 50 min (range 50-75 min). At 3 months, the mRSS score was 0 in two patients and 3-4 in three patients (two patients died).


CONCLUSIONS
According to our results, the microsnare is a safe procedure for mechanical thrombectomy with a good recanalization rate. Further studies are required to determine the role of the microsnare in the treatment of AIS.
González
Alejandro
A
Interventional Neuroradiology, Department of Radiology, Hospital Universitario Virgen del Rocío, C/ Pastor y Landero, 41, 41001 Seville, Spain. jandroglez@terra.es
Mayol
Antonio
A
Martínez
Eva
E
González-Marcos
Jose Ramón
JR
Gil-Peralta
Alberto
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome