title: Early experience with stent retrievers and comparison with previous-generation mechanical thrombectomy devices for acute ischemic stroke.
abstract: OBJECT.: There is limited information regarding patient outcomes following interventions for stroke during the window for endovascular therapy. Studies have suggested that recently approved stent retrievers are safer and more effective than earlier-generation thrombectomy devices. The authors compared cases in which the Solitaire-FR device was used to those in which a MERCI or Penumbra device was used.
  
  
  METHODS
  This study is a single-center retrospective review of 102 consecutive cases of acute stroke in which patients were treated with mechanical thrombectomy devices between 2007 and 2013. Multivariate models, adjusted for confounding factors, were used to investigate functional independence (modified Rankin Scale [mRS] score ≤ 2, and successful reperfusion (thrombolysis in cerebral infarction [TICI] score ≥ 2b).
  
  
  RESULTS
  Thrombectomy device had a significant impact on functional independence (mRS score ≤ 2) at discharge from the hospital (p = 0.040). Solitaire-FR treatment resulted in significantly more patients being discharged as functionally independent in comparison with MERCI treatment (p = 0.016). A multivariate model found the use of Solitaire-FR to improve the odds of good clinical outcome in comparison with prior-generation devices (OR 6.283, 95% CI 1.785-22.119, p = 0.004). Additionally, the use of Solitaire-FR significantly increased the odds of successful reperfusion (OR 3.247, 95% CI 1.160-9.090, p = 0.025).
  
  
  CONCLUSIONS
  The stent retriever Solitaire-FR significantly improved the odds of functional independence and successful revascularization of the arterial tree. New interventional technology for stroke continues to mature, but randomized trials are needed to establish the actual benefit to specific patient populations.
authors.affiliation: Departments of Neurosurgery.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Deshaies
authors.forename: Amit
authors.initials: A
authors.lastname: Singla
authors.forename: Mark R
authors.initials: MR
authors.lastname: Villwock
authors.forename: David J
authors.initials: DJ
authors.lastname: Padalino
authors.forename: Sameer
authors.initials: S
authors.lastname: Sharma
authors.forename: Amar
authors.initials: A
authors.lastname: Swarnkar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome
keywords: ASPECTS = Alberta Stroke Program Early CT Score; IMS-III = Interventional Management of Stroke III; IV = intravenous; MCA = middle cerebral artery; MERCI = mechanical embolus removal in cerebral ischemia; NIHSS = NIH Stroke Scale; TICI = thrombolysis in cerebral infarction; acute ischemic stroke; mRS = modified Rankin Scale; rt-PA = recombinant tissue plasminogen activator; thrombectomy; thrombolysis; vascular disorders