Developments in stent-retriever technology and their potential impact on safety and effectiveness in mechanical thrombectomy of large vessel occlusion stroke

• Published in: Clinical neuroradiology (Munich) 2021-09, Vol.31 (S1), p.S64
• Main Authors: Vogt, Marius, Kollikowski, Alexander, Feick, Jorn, Strinitz, Marc, Weidner, Franziska, Essig, Fabian, Neugebauer, Hermann, Hausler, Karl Georg, Pham, Mirko, Marz, Alexander
• Format: Article
• Language: English
• Subjects: Analysis; Care and treatment; Health aspects; Safety and security measures; Stent (Surgery); Stroke (Disease); Technology and civilization
• ISSN: 1869-1439

Background: To investigate whether current developments in stent retriever technology have an impact on effectiveness and safety in mechanical thrombectomy (MT) of large vessel occlusion (LVO) stroke. Methods: Retrospective data analysis of consecutive patients with LVO stroke treated with MT using either the APERIO[R] or the new generation APERIO[R] Hybrid stent-retriever device in the University hospital Wurzburg between 01/19 and 09/20. Primary effectiveness endpoint was successful recanalization (mTICI [greater than or equal to] 2b), primary safety endpoint was occurrence of hemorrhagic complications after MT. Results: We enrolled 298 consecutive patients: 148 patients (49.7%) treated with AP device vs. 150 patients (50.3%) treated with new generation APH device. In the APH group, the pre-interventional ASPECT score was lower and there was a higher proportion of occlusions in the posterior circulation. In the AP group, more patients received stenting of the internal carotid artery. Other baseline characteristics were without significant differences. Rates of successful recanalization were not different between both groups (86.5% for AP vs. 82.7% for APH; p = 0.361) but postinterventional hemorrhage, particularly subarachnoid hemorrhage (AP: 44 [29.7%] vs. APH: [16.0%]; p = 0.005) occurred significantly less frequent in the APH group. Rates of postinterventional hemorrhage with associated clinical deterioration (sICH) and in domo mortality were not statistically different between groups. Discussion: Both the APERIO[R] and the APERIO[R] Hybrid achieved high rates of successful recanalization (mTICI [greater than or equal to] 2b) in MT of LVO. Detection of hemorrhage on the post-interventional CT scan regardless of its clinical relevance was significantly less frequent in the group treated with the new generation APH. This may be associated in part with refinements of the stent-retriever device, that come with better visibility under fluoroscopy. But when it comes to evaluation of post-interventional hemorrhage after MT, the clinical/neurological course of the patient has to be taken into consideration. By applying different definitions of sICH concomitant with clinical deterioration we found no statistical differences between the two groups. Conclusion: Technological developments and refinements of new generation stent-retriever devices did not alter typical observational indicators of effectiveness but may have a positive impact on safety.