Kim Sung Tae, Jin Sung-Chul, Jeong Hae Woong, Seo Jung Hwa, Ha Sam Yeol, Pyun Hae Wook
Department of Neurosurgery, Busan Paik Hospital, Inje University, Busan, Korea.
Department of Neurosurgery, Haeundae Paik Hospital, Inje University, Busan, Korea.
J Korean Neurosurg Soc. 2014 Dec;56(6):463-8. doi: 10.3340/jkns.2014.56.6.463. Epub 2014 Dec 31.
Unexpected Solitaire stent detachment can occur during mechanical Solitaire thrombectomy. The purpose of this study was to retrospectively evaluate the influencing factors causing unexpected Solitaire stent detachment and the clinical outcomes.
Between October 2011 to December 2013, 232 cases of mechanical Solitaire thrombectomy for acute ischemic stroke were performed in 3 stroke centers. During this period, we encountered unexpected Solitaire stent detachments during mechanical Solitaire thrombectomies in 9 cases.
Solitaire stents unexpectedly detached in 9 cases (3.9%) during the retrieval of Solitaire stents. The median patient age was 76 years. The occlusion sites of the unexpected stent detachment were the proximal middle cerebral artery (MCA) in 7 cases and the internal carotid artery in 2 cases. The sizes of the stents that unexpectedly detached were 6×30 mm in 7 cases, 5×30 mm in 1 case, and 4×20 mm in 1 case. Four patients had unexpected detachment at the first retrieval, 1 patient at the second, 3 patients at the third, and 1 patient at the fifth. In all of the cases of unexpected detachment at the first retrieval, the stent deployment site was the proximal MCA. After detachment, a proximal marker of the Solitaire stent was observed in 3 patients. However, no marker was visible in the remaining 6 patients.
Unexpected Solitaire stent detachment should be considered in the first instance of stent retrieval for a relatively large-diameter stent, especially in elderly patients with MCA occlusions.
在机械取栓过程中，Solitaire支架可能会意外脱落。本研究旨在回顾性评估导致Solitaire支架意外脱落的影响因素及临床结局。
2011年10月至2013年12月期间，3个卒中中心对232例急性缺血性卒中患者进行了机械Solitaire取栓治疗。在此期间，我们在9例机械Solitaire取栓过程中遇到了Solitaire支架意外脱落的情况。
在9例（3.9%）Solitaire支架取栓过程中，支架意外脱落。患者的中位年龄为76岁。意外支架脱落的闭塞部位为大脑中动脉（MCA）近端7例，颈内动脉2例。意外脱落的支架尺寸为6×30mm 7例，5×30mm 1例，4×20mm 1例。4例患者在首次取栓时发生意外脱落，1例在第二次，3例在第三次，1例在第五次。在首次取栓时发生意外脱落的所有病例中，支架置入部位均为MCA近端。脱落后，3例患者观察到Solitaire支架的近端标记。然而，其余6例患者未见标记。
在首次取栓时，对于直径相对较大的支架，尤其是患有MCA闭塞的老年患者，应考虑到Solitaire支架意外脱落的情况。
