Faculty Collaboration Database

Interventional acute ischemic stroke therapy with intracranial self-expanding stent. Stroke 2008 Aug;39(8):2392-5

Date

06/17/2008

Pubmed ID

18556584

DOI

10.1161/STROKEAHA.107.510966

Scopus ID

2-s2.0-49849102583 (requires institutional sign-in at Scopus site)   147 Citations

Abstract

BACKGROUND AND PURPOSE: Rapid and safe recanalization of occluded intracranial arteries in acute ischemic stroke (AIS) is challenging. Newly available self-expanding intracranial atherosclerotic stents (SEIS), which can be deployed rapidly and safely, make acute stenting an option for treating AIS. We present the feasibility of this technique.

METHODS: A retrospective analysis evaluated procedural protocols and clinical response to treatment in patients with AIS treated with SEIS. Descriptive statistics are presented with initial and follow-up National Institutes of Health Stroke Scale and modified Rankin Score.

RESULTS: Nine patients with AIS underwent acute SEIS placement. There was successful deployment of the Neuroform (n=4) and Wingspan (n=4/5) stents in the M1/M2 (n=5) and M3 (n=1) middle cerebral artery segments, intracranial internal carotid artery (one of 2), and intracranial vertebrobasilar junction (one). Mean time of SEIS deployment from AIS onset was 5.1 hours. Complete (Thrombolysis in Cerebral Ischemia/Thrombolysis in Myocardial Ischemia 3) and partial/complete (Thrombolysis in Cerebral Ischemia/Thrombolysis in Myocardial Ischemia 2 or 3) recanalization occurred in 67% and 89%, respectively. One intracranial hemorrhage (11%) and one acute in-stent thrombosis (successfully treated with abciximab and balloon angioplasty) occurred. Stroke-related mortality occurred in 3 of 9 (33%) patients and survivors had modified Rankin Score < or = 2. Follow-up angiography (mean, 8 months; range, 2 to 14 months) in 4 of 9 patients showed no stent restenosis.

CONCLUSIONS: This preliminary experience with SEIS in refractory AIS demonstrated the technical feasibility and high rate of recanalization with acute stenting. Long-term safety and strategies to limit in-stent thrombosis and optimize periprocedural management are crucial before initiating future randomized efficacy studies with SEIS in AIS refractory to standard therapy.

Author List

Zaidat OO, Wolfe T, Hussain SI, Lynch JR, Gupta R, Delap J, Torbey MT, Fitzsimmons BF

MESH terms used to index this publication - Major topics in bold

Acute Disease
Aged
Aged, 80 and over
Angioplasty, Balloon
Brain Ischemia
Combined Modality Therapy
Feasibility Studies
Female
Humans
Infarction, Middle Cerebral Artery
Intracranial Arteriosclerosis
Male
Middle Aged
Platelet Glycoprotein GPIIb-IIIa Complex
Retrospective Studies
Stents
Thrombolytic Therapy
Treatment Outcome