title: Stent-assisted intracranial recanalization for acute stroke: early results.
abstract: OBJECTIVE
  In patients who are not candidates for intravenous tissue plasminogen activator, intra-arterial (IA) therapy is an alternative. Current recanalization rates are 50 to 60% for IA thrombolysis. Stent-assisted recanalization in the setting of acute stroke after failed thrombolysis may improve recanalization rates.
  
  
  METHODS
  A retrospective analysis was performed of 19 patients treated at two institutions between July 2001 and March, 2005 with intracranial stenting of a vessel resistant to standard thrombolytic techniques. Demographics, clinical, and radiographic presentation and outcomes were studied.
  
  
  RESULTS
  Thirteen men and six women with a median baseline National Institutes of Health Stroke Scale (NIHSS) score of 16 (range, 15-22) were included. Eight lesions were located at the internal carotid artery terminus, seven in the M1/M2 segment, and four in the basilar artery. Average time-to-treatment was 210 +/- 160 minutes. Overall recanalization rate (Thrombolysis in Cerebral Infarction Grade 2 or 3) was 79%. There were six deaths: five due to progression of stroke and withdrawal of care at the family's request and one as the result of a delayed carotid injury after tracheostomy. One postoperative asymptomatic intracranial hemorrhage occurred without adverse affect on outcome. Median discharge NIHSS score of surviving patients was 5 (range, 2.5-11.5). Lesions at the internal carotid artery terminus (P < 0.009), older age (P < 0.003), and higher baseline NIHSS score (P < 0.009) were significant negative outcome predictors, as measured by >3 modified Rankin scale score at discharge.
  
  
  CONCLUSIONS
  Stent-assisted recanalization for acute stroke resulting from intracranial thrombotic occlusion is associated with a high recanalization rate and low intracranial hemorrhage rate. These initial results suggest that stenting may be an option for recalcitrant cerebral arterial occlusions.
authors.affiliation: Department of Neurosurgery, Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York 14209, USA.
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.forename: Robert D
authors.initials: RD
authors.lastname: Ecker
authors.forename: Michael B
authors.initials: MB
authors.lastname: Horowitz
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Hanel
authors.forename: Eric
authors.initials: E
authors.lastname: Sauvageau
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
authors.forename: Lee R
authors.initials: LR
authors.lastname: Guterman
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome