What are the criteria for using Inari (thrombectomy device) for thrombectomy?

From the Guidelines

Inari thrombectomy is indicated for patients with acute ischemic stroke (AIS) in whom treatment can be initiated within 6 hours of symptom onset and who have causative occlusion of the internal carotid artery (ICA) or proximal MCA (M1), as stated in the 2018 guidelines for the early management of patients with acute ischemic stroke 1. The criteria for using Inari thrombectomy include:

• Treatment initiation within 6 hours of symptom onset
• Causative occlusion of the ICA or proximal MCA (M1)
• Prestroke mRS score >1, ASPECTS <6, or NIHSS score <6 The technical goal of the thrombectomy procedure should be reperfusion to a modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3 angiographic result to maximize the probability of a good functional clinical outcome, as recommended in the 2018 guidelines 1. Some key points to consider when evaluating patients for Inari thrombectomy include:
• The use of stent retrievers is indicated in preference to the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) device 1
• Reduced time from symptom onset to reperfusion with endovascular therapies is highly associated with better clinical outcomes 1
• The DAWN and DEFUSE 3 eligibility criteria should be strictly adhered to in clinical practice when selecting patients for mechanical thrombectomy 1

From the Research

Criteria for Using Inari Thrombectomy

The criteria for using Inari thrombectomy, a type of mechanical thrombectomy, involve several factors, including:

• The location of the occlusion: Inari thrombectomy is typically used for large vessel occlusions in the anterior circulation, such as the internal carotid or middle cerebral artery 2.
• The time from stroke onset: Inari thrombectomy can be effective up to 24 hours after stroke onset, depending on the patient's selection criteria 2, 3.
• The patient's infarct burden: Patients with a lower infarct burden, as measured by the Alberta Stroke Program Early CT Score (ASPECTS) or infarct volume, may be more likely to benefit from Inari thrombectomy 2.
• The patient's neurological status: Patients with mild deficits, as measured by the National Institutes of Health Stroke Scale (NIHSS), may be more likely to benefit from Inari thrombectomy 2.

Patient Selection

Patient selection is critical to ensure the safe and effective use of Inari thrombectomy. The following factors should be considered:

• The patient's medical history, including any history of bleeding or anticoagulant use 4.
• The patient's imaging results, including CT or MRI scans to determine the location and extent of the occlusion 2, 3.
• The patient's neurological status, including their NIHSS score and any signs of neurological deterioration 2, 3.

Safety and Efficacy

Inari thrombectomy has been shown to be safe and effective in selected patients with acute ischemic stroke. The procedure can increase the chance of achieving a good functional outcome, defined as a modified Rankin Scale score of 0 to 2, without increasing the risk of intracerebral hemorrhage or death 3. However, further studies are needed to confirm these findings and to determine the optimal patient selection criteria for Inari thrombectomy.