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Purpose: Our purpose was to assess the efficacy and safety of the pRESET LITE stent retriever (Phenox, Bochum, Germany), designed for medium vessel occlusion (MeVO) in acute ischemic stroke (AIS) patients with a primary MeVO. Methods: We performed a retrospective analysis of the MAD MT Consortium, an integration of prospectively maintained databases at 37 academic institutions in Europe, North America, and Asia, of AIS patients who underwent mechanical thrombectomy with the pRESET LITE stent retriever for a primary MeVO. We subcategorized occlusions into proximal MeVOs (segments A1, M2, and P1) vs. distal MeVOs/DMVO (segments A2, M3-M4, and P2). We reviewed patient and procedural characteristics, as well as angiographic and clinical outcomes. Results: Between September 2016 and December 2021, 227 patients were included (50% female, median age 78 [65–84] years), of whom 161 (71%) suffered proximal MeVO and 66 (29%) distal MeVO. Using a combined approach in 96% of cases, successful reperfusion of the target vessel (mTICI 2b/2c/3) was attained in 85% of proximal MeVO and 97% of DMVO, with a median of 2 passes (IQR: 1–3) overall. Periprocedural complications rate was 7%. Control CT at day 1 post-MT revealed a hemorrhagic transformation in 63 (39%) patients with proximal MeVO and 24 (36%) patients with DMVO, with ECASS-PH type hemorrhagic transformations occurring in 3 (1%) patients. After 3 months, 58% of all MeVO and 63% of DMVO patients demonstrated a favorable outcome (mRS 0–2). Conclusion: Mechanical thrombectomy using the pRESET LITE in a combined approach with an aspiration catheter appears effective for primary medium vessel occlusions across several centers and physicians. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to evaluate the safety and efficacy of the recently available flow diverter 'pipeline embolization device' (PED) for the treatment of intracranial aneurysms and dissections. Methods: Eighty-eight consecutive patients underwent an endovascular treatment of 101 intracranial aneurysms or dissections using the PED between September 2009 and January 2011. The targeted vessels include 79 (78%) in the anterior circulation and 22 (22%) in the posterior circulation. We treated 96 aneurysms and 5 vessel dissections. Multiple devices were implanted in 67 lesions (66%). Results: One technical failure of the procedure was encountered. Immediate exclusion of the target lesion was not observed. Angiographic follow-up examinations were carried out in 80 patients (91%) with 90 lesions and revealed complete cure of the target lesion(s) in 47 (52%), morphological improvement in 32 lesions (36%), and no improvement in 11 lesions (12%). Six major complications were encountered: one fatal aneurysm rupture, one acute and one delayed PED thrombosis, and three hemorrhages in the dependent brain parenchyma. Conclusion: Our experience reveals that the PED procedure is technically straightforward for the treatment of selected wide-necked saccular aneurysms, fusiform aneurysms, remnants of aneurysms, aneurysms with a high likelihood of failure with conventional endovascular techniques, and dissected vessels. While vessel reconstruction, performed after dissection, is achieved within days, remodeling of aneurysmal dilatations may take several months. Dual platelet inhibition is obligatory. Parenchymal bleeding into brain areas dependent on the target vessel is uncommon. [ABSTRACT FROM AUTHOR]

We evaluated the coronary balloon-expandable cobalt chromium stent Coroflex Blue for the treatment of intracranial atherosclerotic arterial stenoses (IAAS). Between March 2007 and October 2007, a total of 25 patients (20 male, age median 67 years) with 30 IAAS underwent endovascular treatment using Coroflex Blue stents (B. Braun, Germany). Location and degree of target stenoses before and after treatment and at follow-up and adverse clinical sequelae of treatment were registered. Angiographic follow-up was scheduled for 6, 12, 26, and 52 weeks after the treatment. The 30 treated lesions were located as follows: nine in intracranial–extradural internal carotid artery (ICA), three in intradural ICA, five in middle cerebral artery, eight in intradural vertebral artery, and five in basilar artery. The technical success rate was 100%. The degree of stenoses prior to and after treatment was 61 ± 2% and 26 ± 3% (mean ± SE), respectively. A residual stenosis of <50% was achieved in 29 (97%) procedures. Treatment was uneventful in 28 out of 30 procedures (93%); one patient suffered a transient and one patient a permanent neurological deficit. Angiographic follow-up was available in all of the patients (100%) after 15.2 months (median) and showed significant (i.e., more than 50%) degree of recurrent stenosis in 11 (37%) of the lesions. Retreatment was performed in 11 (37%) lesions. The Coroflex Blue stent is easily inserted and safely deployed into intracranial arteries. The incidence of recurrent stenoses remains a concern. Stringent angiographic and clinical follow-up and retreatment are therefore mandatory. [ABSTRACT FROM AUTHOR]

We report an in vitro study comparing the effectiveness of clot removal and clot fragmentation of five embolectomy systems. A flow model was embolized with fresh and old thrombi, occluding an inner diameter of 2–5 mm simulating internal carotid artery (ICA), basilar artery (BA) and middle cerebral artery (MCA) branch occlusion. Embolectomy was performed using five retrieval systems: CATCH (Balt), Merci retriever (Concentric), InTime and Attracter (Boston Scientific), and the Phenox Clot Retriever (Phenox). Clot removal and evidence and type of thrombus fragmentation and distal embolization were recorded. There were no observable differences attributable to thrombus age. The Merci, CATCH and Phenox Clot Retriever were equally able to mobilize and remove thrombi with the exception of one particularly firm clot. There were marked differences in terms of thrombus fragmentation and distal embolization. All devices produced micro- and macrofragments during penetration and retrieval. The Phenox Clot Retriever was able to filter fragments. The InTime and Attracter devices failed to retrieve thrombi in this model and achieved partial removal at best with a tendency towards thrombus displacement and fragmentation. Within limits, the experimental setup was appropriate for generating occlusions of diameter 2–5 mm of various lengths, simulating ICA, BA and MCA thromboembolism. In this model, thrombus mobilization appeared to be less dependent upon the individual design of the retrieval system than on thrombus fragmentation. The ability to prevent distal embolization is, however, strongly dependent on the ability of a thrombectomy device to capture fragments that are generated during removal of the device. [ABSTRACT FROM AUTHOR]