Efficacy and Safety of Solitaire Revascularization Device in Managing Refractory Thrombus in Acute Coronary Syndrome

Background: Use of stent retrievers in managing ischemic stroke has been shown to improve outcomes. Data on stent retrievers in managing intracoronary thrombus are limited. This study aimed to assess the safety and efficacy of the Solitaire revascularization device (Medtronic) in managing recalcitrant intracoronary thrombus. Methods: Patients with acute coronary syndrome and residual large thrombus after treatment with conventional methods underwent treatment with the Solitaire device. The primary efficacy end point was the rate of successful recanalization, defined as Thrombolysis in Myocardial Infarction (TIMI) flow increase to ≥2 or thrombus grade (TG) decrease to ≤2 at postprocedure. Secondary end points included improvements in postprocedure TG and myocardial blush grade. The primary safety end point was occurrence of stroke. Results: Between June 2019 and November 2022, 51 patients underwent thrombectomy with the Solitaire device. The estimated successful recanalization rate was 76.5% (95% CI, 62.0%-87.2%) after Solitaire use and 92.2% (95% CI, 81.1%-97.8%) at the end of the procedure. TG reduced to ≤2 in 28 (54.9%) patients after Solitaire and 43 (84.3%) patients at the end of the procedure. There was significant improvement in myocardial blush grade with an improvement rate of 40% (95% CI, 22.7%-59.4%) after Solitaire and 66.7% (95% CI, 47.2%-82.7%) at the end of procedure. There was no incidence of stroke postprocedurally or up to 30 days postdischarge. Conclusions: The Solitaire device is an effective adjunctive tool in managing recalcitrant intracoronary thrombus, with a low risk of complications.