Solitaire stent retriever reduces disability after stroke

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Patients with acute ischemic stroke had a reduction in the severity of disability and an increase in functional independence after they received mechanical thrombectomy with the Solitaire stent retriever, according to a multicenter, prospective, randomized trial.

Lead researcher Tudor G. Jovin, MD, of the University of Pittsburgh Medical Center in Pennsylvania, and colleagues published their findings online in the New England Journal of Medicine on April 17.

The REVASCAT study included patients who received intravenous alteplase within 4.5 hours after the onset of symptoms without revascularization after 30 minutes of alteplase infusion or who had a contraindication to intravenous alteplase.

Researchers enrolled 206 patients between November 2012 and December 2014 at four stroke centers in Catalonia, Spain, that each treated more than 500 patients with acute stroke and performed more than 60 mechanical stroke thrombectomy procedures per year.

Patients were between 18 and 80 years of age and had a stroke caused by a proximal large-vessel occlusion and an absence of a large infarct on baseline neuroimaging. All patients could be treated within eight hours after the onset of stroke symptoms. They were randomized to receive medical therapy and endovascular therapy with the Solitaire FR stent retriever (Medtronic) or medical therapy alone.

At 90 days, 43.7 percent of patients in the thrombectomy group and 28.2 percent of patients in the control group had functional independence. In addition, the severity of disability was lower in the thrombectomy group, as measured by the distribution of scores on the modified Rankin scale.

Further, 18.4 percent of patients in the thrombectomy group and 15.5 percent of patients in the control group had died at 90 days, while 1.9 percent of patients in each group had symptomatic intracranial hemorrhage at 90 days.