Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy—A Clinical and Biomechanical Perspective
Background: The inadvertent detachment of stent retrievers during mechanical thrombectomy is an extremely rare but feared complication associated with poor clinical outcomes. We discuss management considerations after an unexpected disconnection of the pRESET stent retriever during mechanical thromb...
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doaj-59b829de1f4e45ec8e2f03170b5a29e12021-07-23T13:50:33ZengMDPI AGLife2075-17292021-07-011165865810.3390/life11070658Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy—A Clinical and Biomechanical PerspectivePiotr Piasecki0Marek Wierzbicki1Piotr Tulik2Katarzyna Potocka3Adam Stępień4Jacek Staszewski5Aleksander Dębiec6Jerzy Narloch7Department of Interventional Radiology, Military Institute of Medicine, 04-141 Warsaw, PolandDepartment of Interventional Radiology, Military Institute of Medicine, 04-141 Warsaw, PolandFaculty of Mechatronics, Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, 02-525 Warsaw, PolandFaculty of Mechatronics, Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, 02-525 Warsaw, PolandDepartment of Neurology, Military Institute of Medicine, 04-141 Warsaw, PolandDepartment of Neurology, Military Institute of Medicine, 04-141 Warsaw, PolandDepartment of Neurology, Military Institute of Medicine, 04-141 Warsaw, PolandDepartment of Interventional Radiology, Military Institute of Medicine, 04-141 Warsaw, PolandBackground: The inadvertent detachment of stent retrievers during mechanical thrombectomy is an extremely rare but feared complication associated with poor clinical outcomes. We discuss management considerations after an unexpected disconnection of the pRESET stent retriever during mechanical thrombectomy, based on clinical experience and mechanical and phantom studies. Methods: We present a clinical course of rare accidents of stent-retriever separation inside an intracranial vessel that occurred in patients in a comprehensive stroke centre between 2018 and 2020. We designed a phantom study to assess the Tigertriever’s ability to remove a detached stent retriever from intercranial vessels. In the mechanical study, several types of stent retrievers were evaluated in order to find the weakest point at which detachment occurred. Results: Two patients (~0.7%) with inadvertent stent-retriever detachment were found in our database. Failed attempts of endovascular removal with no recanalization at the end of procedure were reported in both cases. mRS after 3 months was three and four respectively. In the mechanical study, the Tigertriever was the most resistant to detachment and was followed by Embotrap > pRESET > 3D Separator. In the phantom study, the pRESET device detached in a configuration resembling the M1 segment was successfully removed with the Tigertriever. Conclusions: Conservative management of the inadvertent detachment of stent retrievers during mechanical thrombectomy in large vessel occlusion may be acceptable in order to avoid further periprocedural complications after unsuccessful device removal attempts. Based on the phantom and mechanical studies, the Tigertriever may be a useful tool for the removal of detached pRESET devices.https://www.mdpi.com/2075-1729/11/7/658stent-retrieverpRESETinadvertent detachmentmechanical thrombectomyTigertriever |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Piotr Piasecki Marek Wierzbicki Piotr Tulik Katarzyna Potocka Adam Stępień Jacek Staszewski Aleksander Dębiec Jerzy Narloch |
spellingShingle |
Piotr Piasecki Marek Wierzbicki Piotr Tulik Katarzyna Potocka Adam Stępień Jacek Staszewski Aleksander Dębiec Jerzy Narloch Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy—A Clinical and Biomechanical Perspective Life stent-retriever pRESET inadvertent detachment mechanical thrombectomy Tigertriever |
author_facet |
Piotr Piasecki Marek Wierzbicki Piotr Tulik Katarzyna Potocka Adam Stępień Jacek Staszewski Aleksander Dębiec Jerzy Narloch |
author_sort |
Piotr Piasecki |
title |
Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy—A Clinical and Biomechanical Perspective |
title_short |
Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy—A Clinical and Biomechanical Perspective |
title_full |
Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy—A Clinical and Biomechanical Perspective |
title_fullStr |
Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy—A Clinical and Biomechanical Perspective |
title_full_unstemmed |
Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy—A Clinical and Biomechanical Perspective |
title_sort |
inadvertent detachment of stent retrievers during mechanical thrombectomy—a clinical and biomechanical perspective |
publisher |
MDPI AG |
series |
Life |
issn |
2075-1729 |
publishDate |
2021-07-01 |
description |
Background: The inadvertent detachment of stent retrievers during mechanical thrombectomy is an extremely rare but feared complication associated with poor clinical outcomes. We discuss management considerations after an unexpected disconnection of the pRESET stent retriever during mechanical thrombectomy, based on clinical experience and mechanical and phantom studies. Methods: We present a clinical course of rare accidents of stent-retriever separation inside an intracranial vessel that occurred in patients in a comprehensive stroke centre between 2018 and 2020. We designed a phantom study to assess the Tigertriever’s ability to remove a detached stent retriever from intercranial vessels. In the mechanical study, several types of stent retrievers were evaluated in order to find the weakest point at which detachment occurred. Results: Two patients (~0.7%) with inadvertent stent-retriever detachment were found in our database. Failed attempts of endovascular removal with no recanalization at the end of procedure were reported in both cases. mRS after 3 months was three and four respectively. In the mechanical study, the Tigertriever was the most resistant to detachment and was followed by Embotrap > pRESET > 3D Separator. In the phantom study, the pRESET device detached in a configuration resembling the M1 segment was successfully removed with the Tigertriever. Conclusions: Conservative management of the inadvertent detachment of stent retrievers during mechanical thrombectomy in large vessel occlusion may be acceptable in order to avoid further periprocedural complications after unsuccessful device removal attempts. Based on the phantom and mechanical studies, the Tigertriever may be a useful tool for the removal of detached pRESET devices. |
topic |
stent-retriever pRESET inadvertent detachment mechanical thrombectomy Tigertriever |
url |
https://www.mdpi.com/2075-1729/11/7/658 |
work_keys_str_mv |
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