Solitaire stent retriever

Thrombectomy was performed with the Solitaire stent retriever (Covidien, Irvine, CA). Perioperative management strategies were performed as previously described (12 (link), 13 (link)). Intravenous tissue plasminogen activator (rt-PA) was allowed within 4.5 h after the onset of stroke symptoms. Direct thrombectomy without intravenous rtPA treatment was also performed in patients with heavy thrombus burdens or contraindication for intravenous rtPA. Successful recanalization was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b (50–99% reperfusion) or 3 (complete reperfusion) (14 (link)).

The protocols of EVT and perioperative management strategies have been described previously (Hao et al., 2017 (link); Huang et al., 2019 (link); Li et al., 2019 (link)). Briefly, all patients received local anesthesia. Diazepam or dexmedetomidine was used in some patients who did not cooperate with the operation due to disturbance of consciousness. EVT was performed using a Solitaire stent retriever (Covidien, Irvine, CA, United States) or aspiration thrombectomy (Penumbra system, Alameda, CA, United States) as the first choice. If recanalization of targeting artery was not achieved, stent implantation, balloon dilation, or intra-arterial tirofiban administration were used as remedial measures.

The physicians used real-time X-ray technology to visualize the patient’s vascular system and locate IA inside the blood vessel. A solitaire stent retriever (Covidien, Irvine, CA, United States) was used for biopsy specimens’ retrieval from an occluded IA. Cerebral aneurysm and malformed arteries were isolated from cerebral arties using a cutting plane and separating the surfaces on either side of the plane by using a minimally invasive technique. Endothelial cells were derived from human cerebral aneurysm and malformed arteries, and separated with immunomagnetic cell sorting. Briefly, Anti-CD 146-coated Dynabeads (Invitrogen, CA, United States) were prepared according to manufacturer’s instruction and stored at 4°C. Fifty-mg aneurysms were ground with glass pestle and mortar with one-millilter PBS buffer, 0.1% bovine serum albumin, 0.1% sodium azide, and 0.1% a standard broad-spectrum inhibitor cocktail at 4°C. Ten-microliter FcR-blocking agent (Miltenyi, Bergisch Gladbach, Germany) and 25-microliter antibody-coated Dynabeads were added and mixed thoroughly. The samples were mixed in a mixer for 1 h at 4°C and washed four times with PBS inside the Big Easy Magnet (EasySep, United States) at 4°C. Between each washing procedure, the endothelial cells were flushed out with MACS buffer (PBS with 0.5% BSA and 2 mM EDTA, pH 7.0) 10 times in a 100-μL pipette.