Optimizating Clot Retrieval in Acute Stroke The Push and Fluff Technique for Closed-Cell Stentrievers

被引：69

作者：

Haussen, Diogo C. ^{[1
]}

Rebello, Leticia C. ^{[1
]}

Nogueira, Raul G. ^{[1
]}

机构：

[1] Emory Univ, Sch Med, Grady Mem Hosp, Marcus Stroke & Neurosci Ctr, Atlanta, GA USA

来源：

STROKE | 2015年 / 46卷 / 10期

关键词：

cell size; human; reperfusion; stroke; stent; ACUTE ISCHEMIC-STROKE; RANDOMIZED-TRIAL; REVASCULARIZATION; THROMBECTOMY; DEVICE; STENT; TREVO;

D O I：

10.1161/STROKEAHA.115.010044

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose We aimed to investigate the safety and efficacy of the Push and Fluff technique (PFT) as compared with the standard unsheathing technique for closed-cell stent retrievers in acute ischemic stroke. Methods Acute ischemic stroke thrombectomy database was analyzed (September 2010 to January 2015) with the Trevo Retriever as a primary strategy. The PFT was compared with our internal standard unsheathing technique and with the Trevo Versus Merci Retrievers for Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke 2 (TREVO2) trial. Additionally, a silicon flow model was used to compare cell size/configuration, wall apposition/device diameter, and degree of foreshortening/device length across the 2 techniques. Results One hundred fifty-one out of 662 patients qualified for the study. The PFT (n=71) was associated with higher rates of first-pass reperfusion (54% versus 35%, P=0.03; 54% versus 32.6%, P<0.01), lower number of passes (1.30.8 versus 1.8 +/- 1.0, P<0.01; 1.7 +/- 1.0 versus 2.4 +/- 1.6, P<0.01), and higher rates of modified treatment in cerebral ischemia-3 reperfusion (58% versus 40%, P=0.03; 58% versus 14%, P<0.01) as compared with the standard unsheathing technique (n=81) and the TREVO2 Trevo arm (n=88), respectively. No differences in hemorrhagic complications were observed across the groups. The in vitro model indicated that, compared with standard unsheathing technique, PFT resulted in improved wall apposition (device diameter, 75% larger) and cell size (mean area, 51% larger) at the cost of a mild degree of foreshortening (25% length reduction). Conclusions The PFT is safe and leads to optimization of wall apposition and cell size/configuration, resulting in higher chances of first-pass reperfusion, lower number of passes, and better rates of complete reperfusion.

引用

页码：2838 / 2842

页数：5

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