Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions
E.I. Levya,b,c,
R. Mehtaa,
R. Guptaf,
R.A. Hanela,c,
A.J. Chamczuka,
D. Fiorellad,
H.H. Wood,
F.C. Albuquerquee,
T.G. Jovinf,
M.B. Horowitzf and
L.N. Hopkinsa,b,c
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
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Fig 1. Steps involved in sirolimus-eluting stent delivery and deployment. A, A steerable wire is softly advanced through the occlusive clot. B, Placement of stent across occlusion. C, Deployment of stent, thus trapping the occlusion.D, Recanalization.
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Fig 2. A 69-year-old woman with an NIHSS score of 17 who was noted to have a right hemiplegia and aphasia was given an IV bolus dose of tPA because she presented less than 3 hours from symptom onset. She was transferred on an emergency basis to our institution and referred for IA therapy.
A, Angiography (anteroposterior view) reveals a left M1 MCA occlusion (black arrow) with a large anterior temporal branch.
B, A 3.5- x 20-mm Neuroform 3 stent was deployed across the focal area of occlusion after administering an IV bolus dose of eptifibatide (180 µg/kg). Recanalization (TIMI/TICI 3 flow) was re-established in the posterior division of the MCA (dotted black arrow).
C, An unsubtracted image reveals the proximal and distal edges of the stent (black arrowheads).
D, A follow-up run reveals that the anterior division of the MCA is now also patent, but there are filling defects within the stent (arrow demonstrates filling of branch vessels with a filling defect in one of the branches). The patient improved on the day after the procedure to an NIHSS score of 10.
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