A fully radiopaque hybrid stent retriever versus a precursor device: Outcome, efficacy, and safety in large vessel stroke

Comparison of the Aperio Hybrid® and Solitaire FR/X® stents for anterior circulation stroke thrombectomy across different time periods: A propensity score-matched analysis of recanalization and symptomatic hemorrhage

IntroductionThrombectomy has become the standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusions (LVOs). The Aperio Hybrid (Acandis, Pforzheim, Germany) is a new stent retriever designed to enhance the effectiveness of this treatment. However, this new stent has not yet been compared to other thrombectomy devices in a clinical setting. The aim of this study was to compare the Aperio Hybrid® with the Solitaire™ FR/X (Medtronic, Minneapolis, USA) during thrombectomy in patients with AIS due to anterior circulation LVO.Materials and methodsWe analyzed data from a multicenter registry of thrombectomy for anterior circulation LVO. Patients with carotid/M1 or proximal M2 occlusions who underwent thrombectomy with either the Aperio Hybrid® or Solitaire™ FR/X® were compared using propensity-score matching (PSM). The primary outcome was the recanalization rate, measured by the Treatment in Cerebral Ischemia (TICI) score of 2b-3, while the secondary outcome was the rate of symptomatic intracranial hemorrhage (sICH).ResultsAmong 455 patients treated, after PSM, 258 patients (129 per group) were analyzed. The adjusted recanalization rates (TICI 2b-3) for the Aperio Hybrid and Solitaire FR/X were 79.8% and 75.9%, respectively (p = .08), while the adjusted sICH rates were 6.9% and 6.2%, respectively (p = .80).ConclusionsIn this observational study on thrombectomy for AIS, the Aperio Hybrid and Solitaire FR/X demonstrated similar rates of recanalization and symptomatic intracranial hemorrhage. However, due to significant selection bias, these results should be interpreted with caution.

Application of balloon-expandable stent angioplasty with dIstal support of the stent-retriever (BASIS-Stent) technique for acute intracranial artery atherosclerosis-related occlusion

BackgroundRescue stenting may be needed for intracranial atherosclerosis (ICAS)-related large vessel occlusion (LVO). Balloon-expandable (BE) stent implantation often fails due to its stiffness. Balloon-expandable stent angioplasty with the dIstal support of stent-retriever (BASIS-Stent) technique is a novel technique that increases the success and safety of BE stent implantation. Our study presents our initial experience with the BASIS-Stent technique for ICAS-related LVO that requires rescue stenting and to assess its feasibility.

METHOD

The clinical and angiographic data of acute ICAS-related LVO patients treated with the BASIS-Stent technique were retrospectively analyzed. The primary outcome was technical success, defined as successful BE stent implementation (successful deployment and satisfactory expansion). The secondary outcome was good prognosis at 90 days after the procedure, defined as a modified Rankin Scale (mRS) score of 0 to 2. The safety outcomes were procedural-related complications (ie, vessel perforation, dissection, vessel injury, distal embolism), postprocedural re-occlusion, and symptomatic intracranial hemorrhage (sICH).

RESULTS

A total of 19 patients with acute ICAS-related LVO treated at two stroke centers were included, and the median age of the patients was 62 years. Drug-eluting BE stents were successfully implanted in all patients; expanded treatment in cerebral infarction (eTICI) 3 reperfusion was achieved in all patients, no patients experienced procedural-related occlusion, and one (1/19, 5.3%) experienced re-occlusion post-procedure due to in-stent thrombus. None of the patients had sICH. Good clinical outcomes were observed in 13 patients (68.4%), and no patients died.

CONCLUSION

BE stent implantation using the BASIS-Stent technique may be feasible and safe for treating acute ICAS-related LVO.

Thrombectomy for Anterior Circulation Stroke with a Hybrid Cell Design Stent Retriever: A Multicenter Registry

Objective

Thrombectomy is the standard recanalization treatment for acute ischemic stroke (AIS) due to large vessel occlusions (LVO). However, thrombectomy was validated using a few brands of devices. New types of thrombectomy devices have been developed, and assessing their safety and efficacy is essential. This study aimed to evaluate the safety and efficacy of thrombectomy with the Aperio Hybrid stent retriever (Acandis, Pforzheim, Germany) in the treatment of patients with AIS due to anterior circulation LVO.

Methods

This was a multicenter registry of thrombectomy in the treatment of stroke due to anterior circulation LVO. Between January 2022 and January 2024, a total of 128 patients were included.

Results

The mean procedure time was 62 minutes. The rates of the main outcomes were recanalization (extended treatment in cerebral ischemia 2b-3) 102/128 (79.7%), symptomatic intracranial hemorrhage 9/128 (7.0%), good clinical outcome (modified Rankin Scale = 0-2) 67/128 (52.3%), and mortality 24/128 (18.7%) at 3 months.

Conclusion

This study showed that, in a multicenter real-life scenario, the Aperio hybrid stent retriever was safe and effective for thrombectomy of anterior circulation strokes. The outcomes of this study were similar to those of previous large thrombectomy studies.

Safety and Efficacy of the Novel Low-Profile APERIO Hybrid17 for a Treatment of Proximal and Distal Vessel Occlusion in Acute Ischemic Stroke: A Multi-Center Experience

OBJECTIVE

To report our initial experience with the novel low-profile APERIO Hybrid17 Thrombectomy Device (AP17) for proximal and distal vessel occlusions in acute ischemic stroke.

METHODS

A multicentric retrospective analysis of patients treated with the AP17 was performed. The primary effectiveness endpoint was first-pass TICI ≥2b (Thrombolysis in cerebral infarction scale). The primary safety endpoint was the occurrence of hemorrhagic complications. Further outcome measures were number of passes, device-related complications, and 3-month functional outcome.

RESULTS

The AP17 was used in 71 patients (mean age: 73 years) with a median baseline National Institutes of Health Stroke Scale score of 9. Treated vessels were the carotid-T in 8 cases (11%), the M1-segment in 16 (23%), the M2-segment in 29 (41%), the anterior cerebral artery in 3 (4%), and basilar/posterior cerebral arteries in 15 (21%). The rates of first-pass and final TICI ≥2b were 75.6% and 92.7%, retrospectively, with a mean number of passes of 3 ± 2. Final TICI ≥2b rates were comparable between large and medium vessel occlusions. Symptomatic intracranial hemorrhages were recorded in 2 cases (2.8%). At 3-month clinical follow-up, a modified Rankin scale score ≤2 was achieved in 69.0% (29/42). The all-cause mortality at discharge was 17.4%.

CONCLUSIONS

The AP17 was associated with a reasonable safety and efficacy profile for both proximal and distal vessel occlusions. These results may contribute to establish mechanical thrombectomy for distal occlusions.