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Gradual expansion of stent retriever in mechanical thrombectomy for curved middle cerebral artery: structural findings of the stent for predictable recanalization results

  • Original Article - Vascular Neurosurgery - Ischemia
  • Published:
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Abstract

Background

Trevo Provue stent retriever with visible struts under fluoroscopy may be useful in identifying the optimal position and expansion of the stent during the procedure. This study aimed to demonstrate and analyze changes in the segmental diameter of a radio-opaque stent retriever after deployment according to recanalization results, and its relationship with the angle of the occluded segment of the middle cerebral artery (MCA).

Methods

Forty-one patients who underwent mechanical thrombectomy using a Trevo stent retriever were divided into two groups according to Thrombolysis in Cerebral Infarction (TICI) score (TICI 0-2a and TICI 2b/3). The proximal (Pt), middle (Mt), and distal diameter (Dt) of the deployed stent, at three post-deployment waiting times (t = 0, 3, and 5 min), were measured, and ratios of Mt to Pt (Mt/Pt) and of Mt to Dt (Mt/Dt) were calculated.

Results

TICI 2b/3 was achieved in 31 patients (75.6%) and TICI 0-2a in 10 patients (24.4%). In the TICI 2b/3 group, both changes of Mt/Pt (P < 0.001) and Mt/Dt (P = 0.001) until 3 min were significant and all Mt/Pt (each P < 0.01), M3/D3 (P = 0.014), and M5/D5 (P = 0.012) were significantly larger than those in the TICI 0-2a group. The angle of the MCA was significantly correlated with Mt/Pt and Mt/Dt (P < 0.001).

Conclusion

The diameter of the stent retriever after deployment was associated with the recanalization results in mechanical thrombectomy following MCA occlusion.

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Authors and Affiliations

  1. Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea

    Dae Han Choi, Chan Jong Yoo, Cheol Wan Park & Myeong Jin Kim

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  1. Dae Han Choi
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  2. Chan Jong Yoo
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  3. Cheol Wan Park
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  4. Myeong Jin Kim
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Corresponding author

Correspondence to Myeong Jin Kim.

Ethics declarations

All procedures performed in this study were in accordance with the ethical standards of the institute and with the 1964 Helsinki Declaration and its later amendments. Formal consent was not required for the collection of this data.

Informed consent

For this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

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Comments

The authors describe the progressive enlargement of the Trevo stent within a delay of 5 min when placed in the middle cerebral artery during mechanical thrombectomy. The Trevo has the unique advantage of being visible along its entire course, allowing to see the level of wall apposition. According to Choi et al., this is an important prognostic factor in the ability of the stentretriever to extract the clot. This finding has the following consequences:

– Clinical studies and not only experimental studies as achieved up to now need to be done in order to determine whether waiting for several minutes after placement of a stent retriever is needed to achieve a better recanalization but also better clinical outcome as this waiting time has negative consequences in relation to delay of restoral of normal brain perfusion

– All stent retrievers that will be released in the future should be visible in order to assess the level of expansion of the stent retriever

– There is no satisfactory reliable way to compare stent retrievers up to now. The first pass rate seems to be a possible way. The time for complete expansion, as evaluated in this study, may be another way to achieve a comparative analysis among stent retrievers

Rene Chapot

Essen, Germany

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This article is part of the Topical Collection on Vascular Neurosurgery – Ischemia

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Choi, D.H., Yoo, C.J., Park, C.W. et al. Gradual expansion of stent retriever in mechanical thrombectomy for curved middle cerebral artery: structural findings of the stent for predictable recanalization results. Acta Neurochir 161, 2003–2012 (2019). https://doi.org/10.1007/s00701-019-03938-w

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