title: Outcome of standard and high-risk patients with acute anterior circulation stroke after stent retriever thrombectomy.
abstract: OBJECTIVE
  Stent retrievers have become an important tool for the treatment of acute ischemic stroke. The aim of this study was to analyze outcome and complications in a large cohort of patients with stroke treated with the Solitaire stent retriever. The study also included patients who did not meet standard inclusion criteria for endovascular treatment: low or high baseline National Institutes of Health Stroke Scale score, ≥80 years of age, extensive ischemic signs in middle cerebral artery territory, and time from symptom onset to endovascular intervention>8 hours.
  
  
  METHODS
  Consecutive patients with acute anterior circulation stroke treated with the Solitaire FR were analyzed. Data on characteristics of endovascular interventions, complications, and clinical outcome were collected prospectively. Patients who met standard inclusion criteria were compared with those who did not.
  
  
  RESULTS
  A total of 227 patients were included. Mean age was 68.2±14.7 years, and median National Institutes of Health Stroke Scale score on admission was 16 (range, 2-36). Reperfusion was successful (thrombolysis in cerebral infarction, 2b-3) in 70.9%. Outcome was favorable (modified Rankin Scale, 0-2) in 57.7% of patients who met standard inclusion criteria and 30.3% of those who did not. The rates for symptomatic intracranial hemorrhage were 3.7% and 13.1%, for death 11.4% and 33.8%, and for symptomatic intraprocedural complications 2.5% and 4.8%, respectively.
  
  
  CONCLUSIONS
  Patients<80 years of age, without extensive pretreatment ischemic signs, and baseline National Institutes of Health Stroke Scale score≤30 had high rates of favorable outcome and low periprocedural complication rates after Solitaire thrombectomy. Successful reperfusion was also common in patients not fulfilling standard inclusion criteria, but worse clinical outcomes warrant further research with a special focus on optimal patient selection.
authors.affiliation: From the Departments of Diagnostic and Interventional Neuroradiology (P.P.G, S.J., G.S., J.G., P.M., K.H., C.Z.) and Neurology (S.J., M.R.H., H.P.M., M.-L.M., U.F., M.A.), Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Pascal P
authors.initials: PP
authors.lastname: Gratz
authors.forename: Simon
authors.initials: S
authors.lastname: Jung
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
authors.forename: Jan
authors.initials: J
authors.lastname: Gralla
authors.forename: Pasquale
authors.initials: P
authors.lastname: Mordasini
authors.forename: Kety
authors.initials: K
authors.lastname: Hsieh
authors.forename: Mirjam R
authors.initials: MR
authors.lastname: Heldner
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Mono
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Christoph
authors.initials: C
authors.lastname: Zubler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D002533:Cerebral Angiography; D015331:Cohort Studies; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012042:Registries; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: stroke; thrombectomy