title: Middle cerebral artery stenting for acute ischemic stroke after unsuccessful Merci retrieval.
abstract: OBJECTIVE
  Intracranial stenting has been used in the treatment of ischemic stroke caused by acute intracranial vessel occlusion after unsuccessful recanalization with the Merci retriever. We describe our early experience with this technique.
  
  
  METHODS
  Patients who had intra-arterial therapy for acute ischemic stroke with concomitant use of the retriever between February 1, 2005 and May 2, 2006 were identified from our endovascular database. Cases in which recanalization was not achieved with the retriever and in which stenting was attempted as a secondary means of mechanical recanalization were retrospectively reviewed.
  
  
  RESULTS
  Ten patients with unsuccessful Merci retrieval underwent intracranial stenting. The average admission National Institutes of Health Stroke Scale score was 16.4. Occlusions were located in the middle cerebral artery (six extended into M2 branches). Four patients received intra-arterial reteplase (two prestent, one preretriever and poststent, and one poststent). Eptifibatide was administered immediately before stenting in every patient. Successful recanalization (thrombolysis in myocardial infarction 2 or 3) was achieved in nine out of 10 patients. Complications included an extradural perforation with arteriovenous fistula. Six patients had intracranial hematoma and/or subarachnoid hemorrhage; there were four deaths. The six surviving patients experienced at least a 6-point National Institutes of Health Stroke Scale improvement at discharge, although only one had a modified Rankin Scale score of 2 or less.
  
  
  CONCLUSIONS
  Angiographic recanalization has been associated with improvement in clinical outcome after acute cerebral ischemia. Recanalization is not always achieved using the Merci retriever. We found that stenting after unsuccessful Merci retrieval resulted in a high rate of angiographic success. Further research into refining indications and optimizing outcome is warranted.
authors.affiliation: Millard Fillmore Gates Hospital, Kaleida Health, and Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York 14209, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Sauvageau
authors.forename: Rodney M
authors.initials: RM
authors.lastname: Samuelson
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.forename: Alison M
authors.initials: AM
authors.lastname: Jeziorski
authors.forename: Ricky A
authors.initials: RA
authors.lastname: Mehta
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D002545:Brain Ischemia / Q000601:surgery*; D017128:Embolectomy / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015607:Stents; D020521:Stroke / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome