Feasibility and safety of the strategy of first stenting without retrieval using Solitaire FR as a treatment for emergent large-vessel occlusion due to underlying intracranial atherosclerosis

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  • Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea
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OBJECTIVE

The optimal treatment for underlying intracranial atherosclerosis (ICAS) in patients with emergent large-vessel occlusion (ELVO) remains unclear. Reocclusion during endovascular treatment (EVT) occurs frequently (57.1%–77.3%) after initial recanalization with stent retriever (SR) thrombectomy in ICAS-related ELVO. This study aimed to compare treatment outcomes of the strategy of first stenting without retrieval (FRESH) using the Solitaire FR versus SR thrombectomy in patients with ICAS-related ELVO.

METHODS

The authors retrospectively reviewed consecutive patients with acute ischemic stroke and intracranial ELVO of the anterior circulation who underwent EVT between January 2017 and December 2019 at Yeungnam University Medical Center. Large-vessel occlusion (LVO) of the anterior circulation was classified by etiology as follows: 1) no significant stenosis after recanalization (embolic group) and 2) remnant stenosis > 70% or lesser degree of stenosis with a tendency toward reocclusion and/or flow impairment during EVT (ICAS group). The ICAS group was divided into the SR thrombectomy group (SR thrombectomy) and the FRESH group.

RESULTS

A total of 105 patients (62 men and 43 women; median age 71 years, IQR 62.5–79 years) were included. The embolic, SR thrombectomy, and FRESH groups comprised 66 (62.9%), 26 (24.7%), and 13 (12.4%) patients, respectively. There were no significant differences between the SR thrombectomy and FRESH groups in symptom onset–to-door time, but puncture-to-recanalization time was significantly shorter in the latter group (39 vs 54 minutes, p = 0.032). There were fewer stent retrieval passes but more first-pass recanalizations in the FRESH group (p < 0.001). Favorable functional outcomes were significantly more frequent in the FRESH group (84.6% vs 42.3%, p = 0.017).

CONCLUSIONS

This study’s findings suggest that FRESH, rather than rescue stenting, could be a treatment option for ICAS-related ELVO.

ABBREVIATIONS AIS = acute ischemic stroke; ELVO = emergent LVO; EVT = endovascular treatment; FRESH = first stenting without retrieval; ICAS = intracranial atherosclerosis; ICH = intracranial hemorrhage; LVO = large-vessel occlusion; mRS = modified Rankin Scale; mTICI = modified Thrombolysis in Cerebral Infarction; NIHSS = National Institutes of Health Stroke Scale; SR = stent retriever; tPA = tissue plasminogen activator.

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Contributor Notes

Correspondence Chul-Hoon Chang: Yeungnam University Medical Center, Daegu, South Korea. beckham80@hanmail.net.

INCLUDE WHEN CITING Published online January 29, 2021; DOI: 10.3171/2020.8.JNS202504.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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