Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions

• Published in: American Journal of Neuroradiology 2007-05, Vol.28 (5), p.816-822
• Main Authors: Levy, E.I, Mehta, R, Gupta, R, Hanel, R.A, Chamczuk, A.J, Fiorella, D, Woo, H.H, Albuquerque, F.C, Jovin, T.G, Horowitz, M.B, Hopkins, L.N
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Aged, 80 and over; Biological and medical sciences; Cerebral Angiography; Cerebral Revascularization - instrumentation; Cerebral Revascularization - methods; Female; Fibrinolytic Agents - therapeutic use; Humans; Infarction, Middle Cerebral Artery - diagnostic imaging; Infarction, Middle Cerebral Artery - surgery; Interventional; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nervous system; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Stents; Treatment Outcome; Vertebrobasilar Insufficiency - diagnostic imaging; Vertebrobasilar Insufficiency - surgery
• ISSN: 0195-6108; 1936-959X; 1432-1920

Stent-assisted revascularization increases prevailing recanalization rates ( congruent with 50%-69%) for vessel occlusions recalcitrant to thrombolytics. Although balloon-mounted coronary stents can displace thrombus (via angioplasty) and retain clot along vessel walls, intracranial self-expanding stents are more flexible and exert less radial outward force during deployment, increasing deliverability and safety. To understand the effectiveness of self-expanding stents for recanalization of acute cerebrovascular occlusions, we retrospectively reviewed our preliminary experience with these stents. Eighteen patients (19 lesions) presenting with a clinical diagnosis of acute stroke underwent catheter-based angiography documenting focal occlusion of an intracranial artery. A self-expanding stent was delivered to the occlusion and deployed. Stent placement was the initial mechanical maneuver in 6 cases; others involved a combination of pharmacologic and/or mechanical maneuvers prestenting. GP IIb/IIIa inhibitors were administered in 10 cases intraprocedurally or immediately postprocedurally to avoid acute in-stent thrombosis. Stent deployment at the target occlusion (technical success) was achieved in all cases. Thrombolysis in Cerebral Ischemia (TICI)/Thrombolysis in Myocardial Ischemia (TIMI) 2/3 recanalization (angiographic success) was achieved in 15 of 19 lesions (79%). All single-vessel lesions (n=8) were recanalized, but only 7 of 11 combination internal carotid artery and middle cerebral artery lesions were recanalized. No intraprocedural complications occurred. Seven in-hospital deaths occurred: stroke progression, 4; intracranial hemorrhage, 2; respiratory failure, 1. Seven patients had >or=4-point National Institutes of Health Stroke Scale improvement within 24 hours after the procedure, 6 had modified Rankin Score (mRS)