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Partial (SAVE) versus Complete (Solumbra) Stent Retriever Retraction Technique for Mechanical Thrombectomy: A
Magda Jablonska1,2, Jiahui Li2,3, Riccardo Tiberi2,3
1From the 2nd Department of Radiology (M.J.), Medical University of Gdansk, Gdansk, Poland.
AJNR. American Journal of Neuroradiology
|September 14, 2023
Summary
The Solumbra technique for mechanical thrombectomy achieved higher first-pass recanalization rates for soft clots compared to the SAVE technique. Clot characteristics significantly influence the efficacy of stroke treatment methods.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Biomedical Engineering
Background:
- Mechanical thrombectomy is a primary treatment for acute ischemic stroke.
- Various techniques utilize stent retrievers and aspiration catheters.
- Understanding technique efficacy based on clot properties is crucial.
Purpose of the Study:
- To compare the efficacy of two mechanical thrombectomy techniques: stent retriever assisted vacuum-locked extraction (SAVE) and complete retraction (Solumbra).
- To evaluate technique performance based on in vitro clot characteristics (soft vs. stiff).
Main Methods:
- An in vitro model was used to simulate embolization of soft and stiff clots (3x10mm and 2x10mm) in the middle cerebral artery (MCA) M1 segment.
- Mechanical thrombectomy was performed using either the SAVE or Solumbra technique, randomly allocated (1:1).
- Primary endpoint was first-pass recanalization rate; secondary endpoints included distal embolization measures.
Main Results:
- Overall first-pass recanalization was higher with Solumbra (35%) than SAVE (15%) (P<.01).
- For stiff clots, recanalization rates were similar between Solumbra and SAVE (27%; P=.00).
- For soft clots, Solumbra showed higher recanalization (38%) than SAVE (12%) (P<.01), with lower embolus size and area.
Conclusions:
- Clot characteristics significantly impact the effectiveness of mechanical thrombectomy techniques.
- The Solumbra technique demonstrates superior efficacy in achieving first-pass recanalization for soft clots.
- Complete retrieval into distal aspiration catheters (Solumbra) is associated with better outcomes and reduced embolization for soft clots.
