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AJNR - American Journal of Neuroradiology

Published ahead of print on March 19, 2009
doi: 10.3174/ajnr.A1541

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American Journal of Neuroradiology 30:1165-1172, June-July 2009
© 2009 American Society of Neuroradiology

INTERVENTIONAL

Percutaneous Transluminal Angioplasty and Stent Placement in Acute Vessel Occlusion: Evaluation of New Methods for Interventional Stroke Treatment

C. Brekenfeld^a, P. Tinguely^a, G. Schroth^a, M. Arnold^b, M. El-Koussy^a, K. Nedeltchev^b, J.V. Byrne^c and J. Gralla^a

^a Institute of Interventional and Diagnostic Neuroradiology, University of Bern, Switzerland
^b Department of Neurology, University of Bern, Switzerland
^c Department of Neuroradiology, West Wing, John Radcliffe Hospital, Headington, Oxford, UK

Please address correspondence to Jan Gralla, MD, MSc, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Freiburgstr 4, CH-3010 Bern, Switzerland; e-mail: jan.gralla{at}insel.ch

BACKGROUND AND PURPOSE: The major goal of acute ischemic stroke treatment is fast and sufficient recanalization. Percutaneous transluminal balloon angioplasty (PTA) and/or placement of a stent might achieve both by compressing the thrombus at the occlusion site. This study assesses the feasibility, recanalization rate, and complications of the 2 techniques in an animal model.

MATERIALS AND METHODS: Thirty cranial vessels of 7 swine were occluded by injection of radiopaque thrombi. Fifteen vessel occlusions were treated by PTA alone and 15, by placement of a stent and postdilation. Recanalization was documented immediately after treatment and after 1, 2, and 3 hours. Thromboembolic events and dissections were documented.

RESULTS: PTA was significantly faster to perform (mean, 16.6 minutes versus 33.0 minutes for stent placement; P < .001), but the mean recanalization rate after 1 hour was significantly better after stent placement compared with PTA alone (67.5% versus 14.6%, P < .001). Due to the self-expanding force of the stent, vessel diameter further increased with time, whereas the recanalization result after PTA was prone to reocclusion. Besides thromboembolic events related to the passing maneuvers at the occlusion site, no thrombus fragmentation and embolization occurred during balloon inflation or stent deployment. Flow to side branches could also be restored at the occlusion site because it was possible to direct thrombus compression.

CONCLUSIONS: Stent placement and postdilation proved to be much more efficient in terms of acute and short-term vessel recanalization compared with PTA alone.