Recanalization with Wingspan Stent for Acute Middle Cerebral Artery Occlusion in Failure or Contraindication to Intravenous Thrombolysis: A Feasibility Study

• Published in: American journal of neuroradiology : AJNR 2012-06, Vol.33 (6), p.1156-1161
• Main Authors: SUNG, S. M, LEE, T. H, CHO, H. J, SOL, Y. L, PARK, K. H, JUNG, D. S, KIM, C. W
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Blood Vessel Prosthesis; Cerebral Revascularization - instrumentation; Contraindications; Feasibility Studies; Female; Fundamental and applied biological sciences. Psychology; Human; Humans; Infarction, Middle Cerebral Artery - diagnostic imaging; Infarction, Middle Cerebral Artery - surgery; Interventional; Investigative techniques, diagnostic techniques (general aspects); Learning. Memory; Male; Medical sciences; Memory; Middle Aged; Nervous system; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography; Stents; Thrombolytic Therapy; Treatment Outcome
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A2996

Recanalization with the Wingspan stent, which can be deployed rapidly and safely, is an option for treating acute ischemic stroke when intravenous thrombolysis has failed or is contraindicated. This study was performed to evaluate feasibility, efficacy, and safety of recanalization for acute middle cerebral artery occlusion using the Wingspan stent. We collected 10 patients with acute MCA occlusion in whom recanalization was not achieved with a standard intravenous thrombolysis, or who were ineligible for intravenous thrombolysis, or who presented after 3 hours of symptom onset and in whom the stent placement could be completed within 8 hours from symptom onset. We analyzed angiographic and clinical results. Successful recanalization with the Wingspan stent was achieved in all patients. The mean NIHSS score on admission was 12.7 points (range 4-21). The occlusion sites were located in the 1st segment (n = 7; 2 left, 5 right) and 2nd segment (n = 3, all right) of the MCA. The mean time interval from stroke symptom onset to stent placement was 344.8 ± 76.3 minutes. No intracranial hemorrhage, vessel perforations, or dissections occurred in any patient. Nine patients improved on the NIHSS at 7 days. One patient did not have a change in the NIHSS score, even though the occluded artery was completely recanalized. At 7 days, the NIHSS score of all patients was 4.4 ± 4.7 (median 4, range 0-13). At discharge, an mRS of ≤ 3 was achieved in all patients and an mRS of ≤ 2 was achieved in 7 patients (70%). This small case series demonstrates the feasibility of using the Wingspan stent safely and effectively for MCA occlusions when standard treatments are ineffective or not available.