Selected in American Journal of Neuroradiology by JITTAPIROMSAK Pakrit
Authors: Yang D, Hao Y, Zi W, Wang H, Zheng D, Li H, Tu M, Wan Y, Jin P, Xiao G, Xiong Y, Xu G, Liu X.
Reference: AJNR Am J Neuroradiol. 2017 Aug;38(8):1586-1593
Published: August 2017
Retrieving material is one of the major variables in mechanical thrombectomy for stroke treatment. Stent size is one of the concerns when working on different vascular diameters.
This is a retrospective study from 21 stroke centers in China. Data from treatment of anterior circulation ischemic stroke (ICA, M1, M2, A1, A2) with Solitaire 6-mm (n=256) and Solitaire 4-mm (n=372) were collected. Cases were systematically matched in clinical severity and occluded site to compare outcomes. There was no obvious difference in reperfusion rate and functional outcome regarding stent sizes. Higher reperfusion rate was observed in a subgroup with atherosclerotic disease treated with smaller stent.
There is no obvious difference using stent in between sizes. However, due to retrospective design, it is unavoidable to have selection bias. No measurement of target vascular diameter is my major concern. In my opinion, the operating doctor usually selects a stent matching target vessel diameter. Smaller 4-mm stent with shorter design is usually acceptable with MCA and atherosclerotic ICA. Larger 6-mm stent with longer design will fit for ICA, not for MCA. This could explain the better results with smaller stent in subgroup analysis.
Wrap-up: More patients, less disability