Evaluation of the Solitaire System in a Canine Arterial Thromboembolic Occlusion Model: Is it Safe for the Endothelium?

Abstract

The Solitaire system has recently been increasingly used for acute stroke treatment in which the endothelial safety immediately after its use has not been evaluated. This study was performed to evaluate the endothelial status when using a Solitaire system in a canine arterial occlusion model.

Thromboembolic occlusion of both internal maxillary arteries was achieved in five mongrel dogs. In each animal, the Solitaire system (ev3, Irvine, CA, USA) was used for primary thrombectomy on the right side and for temporary stenting on the left side. Efficacy was assessed by comparing the recanalization rates, and safety was assessed using angiographic and microscopic assessments. Endothelial injuries were evaluated with light microscopy (LM) and scanning electron microscopy (SEM).

Successful revascularizations were observed following primary thrombectomy in all five animals (100%) and after temporary stenting in two (40%). There was no incidence of vasospasm or vessel perforation in either group. Distal migration of the clot occurred in two animals that underwent primary thrombectomy. Endothelial injury was seen after primary thrombectomy in two animals (40%) and after temporary stenting in one (20%). The lesions presented as defects of the internal elastic lamina on LM and denudation of the wavy endothelial surface on SEM.

During mechanical thrombectomy, the Solitaire system can cause endothelial injury both in primary thrombectomy and temporary stenting. Primary thrombectomy is likely to have a higher recanalization rate with increased endothelial injury.

Keywords

stroke thrombectomy stents animal model endothelium

Get full access to this article

View all access options for this article.

References

Castano

Dorado

Guerrero

. Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke. 2010; 41: 1836–1840.

Stampfl

Hartmann

Ringleb

. Stent placement for flow restoration in acute ischemic stroke: a single-center experience with the Solitaire stent system. Am J Neuroradiol. 2011; 32: 1245–1248.

Machi

Costalat

Lobotesis

. Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients. J Neurointerv Surg. 2012; 4: 62–66.

Cohen

Gomori

Leker

. Recanalization with stent-based mechanical thrombectomy in anterior circulation major ischemic stroke. J Clin Neurosci. 2012; 19: 39–43.

Roth

Papanagiotou

Behnke

. Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke. 2010; 41: 2559–2567.

Mordasini

Frabetti

Gralla

. In vivo evaluation of the first dedicated combined flow-restoration and mechanical thrombectomy device in a swine model of acute vessel occlusion. Am J Neuroradiol. 2011; 32: 294–300.

Smith

Sung

Saver

. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke. 2008; 39: 1205–1212.

Kim

Lee

Kwon

. Treatment of acute ischemic stroke: feasibility of primary or secondary use of a self-expanding stent (Neuroform) during local intra-arterial thrombolysis. Neuroradiology. 2012; 54: 35–41.

Levy

Mehta

Gupta

. Self-expanding stents for recanalization of acute cerebrovascular occlusions. Am J Neuroradiol. 2007; 28: 816–822.

10.

Levy

Sauvageau

Hanel

. Self-expanding versus balloon-mounted stents for vessel recanalization following embolic occlusion in the canine model: technical feasibility study. Am J Neuroradiol. 2006; 27: 2069–2072.

11.

Levy

Ecker

Horowitz

. Stent-assisted intracranial recanalization for acute stroke: early results. Neurosurgery. 2006; 58: 458–463; discussion 458–463.

12.

Suh

Lee

Hong

. Temporary stenting and retrieval of the self-expandable, intracranial stent in acute middle cerebral artery occlusion. Neuroradiology. 2009; 51: 541–544.

13.

Kelly

Furlan

Fiorella

. Recanalization of an acute middle cerebral artery occlusion using a self-expanding, reconstrainable, intracranial microstent as a temporary endovascular bypass. Stroke. 2008; 39: 1770–1773.

14.

The TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med. 1985; 312: 932–936.

15.

Nogueira

Levy

Gounis

. The Trevo device: preclinical data of a novel stroke thrombectomy device in two different animal models of arterial thrombo-occlusive disease. J Neurointerv Surg. 2012; 4: 295–300.

16.

Jahan

. Solitaire flow-restoration device for treatment of acute ischemic stroke: safety and recanalization efficacy study in a swine vessel occlusion model. Am J Neuroradiol. 2010; 31: 1938–1943.

17.

Miteff

Faulder

Goh

. Mechanical thrombectomy with a self-expanding retrievable intracranial stent (Solitaire AB): experience in 26 patients with acute cerebral artery occlusion. Am J Neuroradiol. 2011; 32: 1078–1081.

18.

Seifert

Ahlbrecht

Dohmen

. Combined interventional stroke therapy using intracranial stent and local intraarterial thrombolysis (LIT). Neuroradiology. 2011; 53: 273–282.

19.

Krischek

Miloslavski

Fischer

. A comparison of functional and physical properties of self-expanding intracranial stents [Neuroform3, Wingspan, Solitaire, Leo+, Enterprise]. Minim Invasive Neurosurg. 2011; 54: 21–28.