Abstract
Introduction
Quicker recanalization results in better clinical outcomes in patients with acute ischemic strokes. We describe our experience with the use of a self-expanding, fully retrievable stent in acute intracranial occlusions.
Methods
Patients who underwent intra-arterial procedures with a self-expanding, fully retrievable stent for acute ischemic strokes at our center in 2009 were included in this study. The primary outcome was recanalization [Thrombolysis in Myocardial Infarction (TIMI) grade 2/3] at end of procedure. Secondary endpoints were procedural interval times, incidence of vasospasm, rupture of vessels, device-related complications, groin complications, postprocedural intracerebral hemorrhage (ICH) on noncontrast CT, and all-cause mortality.
Results
Fourteen patients (mean age 62.1 years, range 34–81 years; six males) were included in the study. Sites of occlusion are as follows: M1 middle cerebral artery (MCA, n = 8), M2 MCA (n = 1), proximal basilar artery (n = 1), and distal basilar artery (n = 4). An additional device or technique was used in 9 of 14 patients prior to the use of the retrievable stent. Twelve out of 14 (85.7%) achieved TIMI 2–3 recanalization with 4 of 14 (28.6%) achieving TIMI 3. Eight of 14 (57.1%) patients had modified Rankin Scale (0–2) at 3 months or discharge. ICH on follow-up CT was noted in 28.6% (4 of 14) of patients. All-cause mortality was 2 of 14 (14.3%).
Conclusion
Use of a novel self-expanding, fully retrievable stent resulted in fast and very high recanalization rates in acute ischemic strokes with intravascular occlusions.
Similar content being viewed by others
References
Rha JH, Saver JL (2007) The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 38(3):967–973
Khatri P, Abruzzo T, Yeatts SD, Nichols C, Broderick JP, Tomsick TA (2009) Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology 73(13):1066–1072
Smith WS (2006) Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I. AJNR Am J Neuroradiol 27(6):1177–1182
Penumbra Pivotal Stroke Trial Investigators (2009) The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 40(8):2761–2768
Levy EI, Siddiqui AH, Crumlish A et al (2009) First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (stent-assisted recanalization in acute ischemic stroke). Stroke 40(11):3552–3556
Mocco J, Hanel RA, Sharma J et al (2010) Use of a vascular reconstruction device to salvage acute ischemic occlusions refractory to traditional endovascular recanalization methods. J Neurosurg 112(3):557–562
Castano C, Dorado L, Guerrero C et al (2010) Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke 41(8):1836–1840
Suh SH, Kim BM, Roh HG et al (2010) Self-expanding stent for recanalization of acute embolic or dissecting intracranial artery occlusion. AJNR Am J Neuroradiol 31(3):459–463
Khatri P, Hill MD, Palesch YY et al (2008) Methodology of the Interventional Management of Stroke III Trial. Int J Stroke 3(2):130–137
Hill MD, Moy CS, Palesch YY et al (2007) The albumin in acute stroke trial (ALIAS); design and methodology. Int J Stroke 2(3):214–219
IMS Study Investigators (2004) Combined intravenous and intra-arterial recanalization for acute ischemic stroke: the Interventional Management of Stroke Study. Stroke 35(4):904–911
Hacke W, Kaste M, Fieschi C et al (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 352(9136):1245–1251
Demchuk AM, Hill MD, Barber PA, Silver B, Patel SC, Levine SR (2005) Importance of early ischemic computed tomography changes using ASPECTS in NINDS rtPA Stroke Study. Stroke 36(10):2110–2115
Hill MD, Demchuk AM, Tomsick TA, Palesch YY, Broderick JP (2006) Using the baseline CT scan to select acute stroke patients for IV-IA therapy. AJNR Am J Neuroradiol 27(8):1612–1616
Kelly ME, Furlan AJ, Fiorella D (2008) Recanalization of an acute middle cerebral artery occlusion using a self-expanding, reconstrainable, intracranial microstent as a temporary endovascular bypass. Stroke 39(6):1770–1773
Menon BK, Hill MD, Eesa M et al (2010) Initial experience with the Penumbra Stroke System for recanalization of large vessel occlusions in acute ischemic stroke. Neuroradiology. doi:10.1007/s00234-010-0725-2
Smith WS, Sung G, Saver J et al (2008) Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39(4):1205–1212
Furlan A, Higashida R, Wechsler L et al (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282(21):2003–2011
Roth C, Papanagiotou P, Behnke S et al (2010) Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke 41(11):2559–2567
Zaidat OO, Wolfe T, Hussain SI et al (2008) Interventional acute ischemic stroke therapy with intracranial self-expanding stent. Stroke 39(8):2392–2395
Riedel CH, Tietke M, Alfke K, Stingele R, Jansen O (2009) Subacute stent thrombosis in intracranial stenting. Stroke 40(4):1310–1314
Qureshi AI, Feldmann E, Gomez CR et al (2009) Intracranial atherosclerotic disease: an update. Ann Neurol 66(6):730–738
Uyttenboogaart M, Koch MW, Koopman K, Vroomen PC, De Keyser J, Luijckx GJ (2008) Safety of antiplatelet therapy prior to intravenous thrombolysis in acute ischemic stroke. Arch Neurol 65(5):607–611
Acknowledgments
We acknowledge the contributions of Drs. Shelagh B Coutts, Michael D Hill, Timothy WJ Watson, Eric E Smith, Phil Barber, Peter K Stys, Gary Klein, stroke fellows and residents, and all other members of the Calgary Stroke Program. We also acknowledge the contribution of the neuroradiology and neurosurgery teams at the Foothills Medical Center and technical support from the Seaman Family MR Center.
Conflict of interest
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Menon, B.K., Kochar, P., Ah-Seng, A. et al. Initial experience with a self-expanding retrievable stent for recanalization of large vessel occlusions in acute ischemic stroke. Neuroradiology 54, 147–154 (2012). https://doi.org/10.1007/s00234-010-0835-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-010-0835-x