Double stent-retriever as the first-line approach in mechanical thrombectomy: a randomized in vitro evaluation

BackgroundA repeated number of passes during mechanical thrombectomy leads to worse clinical outcomes in acute ischemic stroke. Initial experiences with the simultaneous double stent-retriever (double-SR) technique as the first-line treatment showed promising safety and efficacy results. ObjectiveTo characterize the potential benefits of using the double-SR as first-line technique as compared with the traditional single-SR approach. MethodsThree types of clot analogs (soft, moderately stiff, and stiff) were used to create terminal internal carotid artery (T-ICA=44) and middle cerebral artery (MCA=88) occlusions in an in vitro neurovascular model. Sixty-six cases were randomized into each treatment arm: single-SR or double-SR, in combination with a 0.071 distal aspiration catheter. A total of 132 in vitro thrombectomies were performed. Primary endpoints were the rate of first-pass recanalization (%FPR) and procedural-related distal emboli. ResultsFPR was achieved in 42% of the cases. Overall, double-SR achieved a significantly higher %FPR than single-SR (52% vs 33%, P=0.035). Both techniques showed similar %FPR in T-ICA occlusions (single vs double: 23% vs 27%, P=0.728). Double-SR significantly outperformed single-SR in MCA occlusions (63% vs 38%, P=0.019), most notably in saddle occlusions (64% vs 14%, P=0.011), although no significant differences were found in single-branch occlusions (64% vs 50%, P=0.275). Double-SR reduced the maximal size of the clot fragments migrating distally (Feret diameter=1.08 +/- 0.65 mm vs 2.05 +/- 1.14 mm, P=0.038). ConclusionsThis randomized in vitro evaluation demonstrates that the front-line double-SR technique is more effective than single-SR in achieving FPR when treating MCA bifurcation occlusions that present saddle thrombus.

Automated summary

This in vitro evaluation compared the efficacy of single and double Sensormedics balloon catheters in mechanical thrombectomy. The results showed that the double-SR technique was more effective in achieving first-pass recanalization and reducing distal emboli especially in MCA bifurcation occlusions.