title: Comparison of non-stent retriever and stent retriever mechanical thrombectomy devices for the endovascular treatment of acute ischemic stroke.
abstract: OBJECTIVE Mechanical thrombectomy is standard of care for the treatment of acute ischemic stroke. However, limited data are available from assessment of outcomes of FDA-approved devices. The objective of this study is to compare clinical outcomes, efficacy, and safety of non-stent retriever and stent retriever thrombectomy devices. METHODS Between January 2008 and June 2014, 166 patients treated at Jefferson Hospital for Neuroscience for acute ischemic stroke with mechanical thrombectomy using Merci, Penumbra, Solitaire, or Trevo devices were retrospectively reviewed. Primary outcomes included 90-day modified Rankin Scale (mRS) score, recanalization rate (thrombolysis in cerebral infarction [TICI score]), and incidence of symptomatic intracranial hemorrhages (ICHs). Univariate analysis and multivariate logistic regression determined predictors of mRS Score 3-6, mortality, and TICI Score 3. RESULTS A total of 99 patients were treated with non-stent retriever devices (Merci and Penumbra) and 67 with stent retrievers (Solitaire and Trevo). Stent retrievers yielded lower 90-day NIH Stroke Scale scores and higher rates of 90-day mRS scores ≤ 2 (22.54% [non-stent retriever] vs 61.67% [stent retriever]; p < 0.001), TICI Score 2b-3 recanalization rates (79.80% [non-stent retriever] vs 97.01% [stent retriever]; p < 0.001), percentage of parenchyma salvaged, and discharge rates to home/rehabilitation. The overall incidence of ICH was also significantly lower (40.40% [non-stent retriever] vs 13.43% [stent retriever]; p = 0.002), with a trend toward lower 90-day mortality. Use of non-stent retriever devices was an independent predictor of mRS Scores 3-6 (p = 0.002), while use of stent retrievers was an independent predictor of TICI Score 3 (p < 0.001). CONCLUSIONS Stent retriever mechanical thrombectomy devices achieve higher recanalization rates than non-stent retriever devices in acute ischemic stroke with improved clinical and radiographic outcomes and safety.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Max E
authors.initials: ME
authors.lastname: Hentschel
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Badih
authors.initials: B
authors.lastname: Daou
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Nohra
authors.initials: N
authors.lastname: Chalouhi
authors.affiliation: Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Shannon
authors.initials: S
authors.lastname: Clark
authors.affiliation: Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania; and.
authors.forename: Ashish
authors.initials: A
authors.lastname: Gandhe
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenwasser
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Stavropoula
authors.initials: S
authors.lastname: Tjoumakaris
mesh_terms: D002545:Brain Ischemia; D006801:Humans; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke; D017131:Thrombectomy; D016896:Treatment Outcome
keywords: AIS = acute ischemic stroke; CTP = CT perfusion; DWI = diffusion-weighted imaging; ICH = intracranial hemorrhage; JHN = Jefferson Hospital for Neuroscience; NIHSS = NIH Stroke Scale; TICI = thrombolysis in cerebral infarction; endovascular procedures; interventional neurosurgery; mRS = modified Rankin Scale; stroke; tPA = tissue plasminogen activator; thrombectomy; vascular disorders