SOLITAIRE™ with the Intention for Thrombectomy (SWIFT) Trial: Design of a Randomized, Controlled, Multicenter Study Comparing the SOLITAIRE™ Flow Restoration Device and the MERCI Retriever in Acute Ischaemic Stroke

Author:

Saver J. L.1,Jahan R.2,Levy E. I.3,Jovin T. G.4,Baxter B.5,Nogueira R.6,Clark W.7,Budzik R.8,Zaidat O. O.9,

Affiliation:

1. Department of Neurology and Stroke Center, UCLA, Los Angeles, California, USA

2. Department of Radiology and Stroke Center, UCLA, Los Angeles, California, USA

3. Department of Neurosurgery, Millard Fillmore Hospital, Buffalo, New York, USA

4. Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

5. Department of Radiology, Erlanger Hospital, Chatanooga, Tennessee, USA

6. Department of Neurology, Emory University, Atlanta, Georgia, USA

7. Department of Neurology, Oregon Health Science University, Portland, Oregon, USA

8. Department of Radiology, Riverside Methodist Hospital, Columbus, Ohio, USA

9. Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Abstract

Rationale Self-expanding stent retrievers are a promising new device class designed for rapid flow restoration in acute cerebral ischaemia. The SOLITAIRE™ Flow Restoration device (SOLITAIRE) has shown high rates of recanalization in preclinical models and in uncontrolled clinical series. Aims ( 1 ) To demonstrate non-inferiority of SOLITAIRE compared with a legally marketed device, the MERCI Retrieval System®; ( 2 ) To demonstrate safety, feasibility, and efficacy of SOLITAIRE in subjects requiring mechanical thrombectomy diagnosed with acute ischaemic stroke. Design Multicenter, randomized, prospective, controlled trial with blinded primary end-point ascertainment. Study Procedures Key entry criteria include: age 22–85; National Institute of Health Stroke Scale (NIHSS) ≥8 and <30; clinical and imaging findings consistent with acute ischaemic stroke; patient ineligible or failed intravenous tissue plasminogen activator; accessible occlusion in M1 or M2 middle cerebral artery, internal carotid artery, basilar artery, or vertebral artery; and patient able to be treated within 8 h of onset. Sites first participate in a roll-in phase, treating two patients with the SOLITAIRE device, before proceeding to the randomized phase. In patients unresponsive to the initially assigned therapy, after the angiographic component of the primary end-point is ascertained (reperfusion with the initial assigned device), rescue therapy with other reperfusion techniques is permitted. Outcomes The primary efficacy end-point is successful recanalization with the assigned study device (no use of rescue therapy) and with no symptomatic intracranial haemorrhage. Successful recanalization is defined as achieving Thrombolysis In Myocardial Ischemia 2 or 3 flow in all treatable vessels. The primary safety end-point is the incidence of device-related and procedure-related serious adverse events. A major secondary efficacy end-point is time to achieve initial recanalization. Additional secondary endpoints include clinical outcomes at 90 days and radiologic haemorrhagic transformation.

Publisher

SAGE Publications

Subject

Neurology

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