American Journal of Neuroradiology 28:816-822, May 2007
© 2007 American Society of Neuroradiology
INTERVENTIONAL
Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions
a Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo NY
b Department of Radiology, Millard Fillmore Gates Hospital, University at Buffalo, State University of New York, Buffalo NY
c Kaleida Health and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo NY
d Section of Cerebrovascular and Endovascular Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio
e Barrow Neurological Institute, Phoenix, Ariz
f Departments of Neurosurgery and Radiology, University of Pittsburgh Medical Center/Presbyterian University Hospital, Pittsburgh, Pa
Address correspondence to Elad I. Levy, MD, University at Buffalo Neurosurgery, Kaleida Health/Millard Gates Hospital, 3 Gates Circle, Buffalo, NY 14209; e-mail elevy{at}buffns.com
BACKGROUND AND PURPOSE: Stent-assisted revascularization increases prevailing recanalization rates (
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.
MATERIALS AND METHODS: 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.
RESULTS: 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 
4-point National Institutes of Health Stroke Scale improvement within 24 hours after the procedure, 6 had modified Rankin Score (mRS) 
3 at discharge, and 4 had mRS 3 at 3 months. Overall, revascularization and improvement in clinical outcome were more likely to occur in women.
CONCLUSION: Feasibility of self-expanding stents for treatment of acute symptomatic intracranial occlusions is shown. For single-vessel lesions, stent placement with concomitant administration of IIb/IIIa inhibitors contributed to the achievement of recanalization rates exceeding those currently reported for other means of thrombolysis.
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