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Improved first-pass effect in acute stroke thrombectomy using Solitaire-X compared to Solitaire-FR.

Ron Biederko1, Asaf Honig2,3, Ksenia Shabad2

  • 1Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel.

Frontiers in Neurology
|November 6, 2023
PubMed
Summary

The Solitaire-X device demonstrated superior outcomes in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT) for large vessel occlusion (LVO). This new device improved first-pass recanalization and clinical results compared to the Solitaire-FR.

Keywords:
Solitaire-FRSolitaire-XSolumbra techniqueacute ischemic strokeendovascular thrombectomyfirst pass effectlarge vessel occlusionpusher wire

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Area of Science:

  • Neurology and Interventional Neuroradiology
  • Cerebrovascular Diseases
  • Medical Devices and Technology

Background:

  • Acute ischemic stroke (AIS) treatment via endovascular thrombectomy (EVT) for large vessel occlusion (LVO) requires optimal device selection.
  • The Solitaire-X device features longer and larger diameter pusher wires compared to the Solitaire-FR, with its impact on outcomes being uncertain.

Purpose of the Study:

  • To compare procedural, clinical, and radiological outcomes between Solitaire-X and Solitaire-FR devices in AIS patients undergoing EVT.
  • To evaluate the efficacy of the Solitaire-X device, particularly its larger pusher-wire diameter, in achieving successful reperfusion.

Main Methods:

  • Retrospective analysis of a prospective multicenter registry of consecutive AIS patients undergoing EVT for LVO.
  • Patients treated with Solitaire-X were compared to a cohort treated with Solitaire-FR, excluding those with tandem lesions or requiring emergent stenting.
  • Primary outcome: successful first-pass recanalization (TICI 2b/3). Secondary outcomes: recanalization rates, NIHSS, hospitalization duration, ASPECT scores, and hemorrhagic transformation.

Main Results:

  • The Solitaire-X group showed a significantly higher rate of first-pass recanalization (65.9% vs. 50.5%, p=0.049).
  • Solitaire-X was associated with improved radiological outcomes, including higher ASPECT scores (6.51 vs. 5.49, p=0.042) and lower bleeding volumes (0.67 vs. 1.20 mL, p=0.041).
  • Patients treated with Solitaire-X experienced shorter hospitalization durations (16.6 vs. 25.1 days, p=0.033), and it was the sole independent predictor of first-pass recanalization (OR 2.17).

Conclusions:

  • The Solitaire-X device, with its larger pusher-wire diameter, is associated with a higher likelihood of achieving first-pass reperfusion in AIS patients.
  • The use of Solitaire-X leads to improved procedural, clinical, and radiological outcomes compared to the Solitaire-FR device.
  • This suggests that the Solitaire-X represents an advancement in EVT devices for LVO, enhancing treatment effectiveness.