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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:2069-2072, November-December 2006
© 2006 American Society of Neuroradiology

INTERVENTIONAL

Self-Expanding Versus Balloon-Mounted Stents for Vessel Recanalization Following Embolic Occlusion in the Canine Model: Technical Feasibility Study

E.I. Levy^a, E. Sauvageau^a, R.A. Hanel^a, R. Parikh^b and L.N. Hopkins^a

^a Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY
^b Boston Scientific Neurovascular/Boston Scientific Corporation, Fremont, Calif

Please address correspondence to Elad I. Levy, MD, Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Three Gates Circle, Buffalo, NY 14209

BACKGROUND AND PURPOSE: Despite advances in mechanical thrombolysis for acute stroke, recanalization rates remain approximately 50%–60%. Technologic improvements allowed safe intracranial delivery of stents. To study the feasibility of stent-assisted recanalization for acute stroke, we deployed self-expanding or balloon-mounted stents in 2- to 3.5-mm canine vessels acutely occluded with clot emboli.

METHODS: Six mongrel dogs were placed under general anesthesia. A guiding catheter was placed in the distal vertebral artery or an external carotid artery branch. A 7 x 3 mm (length x diameter) soft or hard clot was injected into the catheter and allowed to embolize distally; 20 vessels were successfully occluded. After systemic heparin anticoagulation, recanalization with a self-expanding stent was attempted in 11 vessels (5 occluded with soft clot; 6, with hard clot). Balloon-mounted stents were placed in an attempt to revascularize 9 vessels (4 occluded with soft clot; 5, with hard clot). Vessel recanalization was assessed as the primary end point. Side-branch occlusion and stent-induced vasospasm were also assessed.

RESULTS: Thrombolysis in Myocardial Infarction/Thrombolysis in Cerebral Infarction flow for 11 vessels treated with self-expanding stents versus 9 treated with balloon-mounted stents was as follows: grade 3, 91% of vessels versus 78% of vessels; grade 2, 0% versus 11%; grade 1, 9% versus 0%; grade 0, 0% versus 11%. Lower rates of spasm and side-branch occlusion were noticed with self-expanding stents. Grade 2/3 flow was achieved in 18/20 vessels (90%).

CONCLUSIONS: Excellent recanalization was demonstrated with both stents. Recanalization in self-expanding stents was achieved without pre- or post-balloon dilation. Stents may prove to be a useful adjunct for intra-arterial acute stroke treatment.

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