title: Self-expanding stents for recanalization of acute cerebrovascular occlusions.
abstract: OBJECTIVE
  Stent-assisted revascularization increases prevailing recanalization rates ( congruent with 50%-69%) for vessel occlusions recalcitrant to thrombolytics. Although balloon-mounted coronary stents can displace thrombus (via angioplasty) and retain clot along vessel walls, intracranial self-expanding stents are more flexible and exert less radial outward force during deployment, increasing deliverability and safety. To understand the effectiveness of self-expanding stents for recanalization of acute cerebrovascular occlusions, we retrospectively reviewed our preliminary experience with these stents.
  
  
  METHODS
  Eighteen patients (19 lesions) presenting with a clinical diagnosis of acute stroke underwent catheter-based angiography documenting focal occlusion of an intracranial artery. A self-expanding stent was delivered to the occlusion and deployed. Stent placement was the initial mechanical maneuver in 6 cases; others involved a combination of pharmacologic and/or mechanical maneuvers prestenting. GP IIb/IIIa inhibitors were administered in 10 cases intraprocedurally or immediately postprocedurally to avoid acute in-stent thrombosis.
  
  
  RESULTS
  Stent deployment at the target occlusion (technical success) was achieved in all cases. Thrombolysis in Cerebral Ischemia (TICI)/Thrombolysis in Myocardial Ischemia (TIMI) 2/3 recanalization (angiographic success) was achieved in 15 of 19 lesions (79%). All single-vessel lesions (n=8) were recanalized, but only 7 of 11 combination internal carotid artery and middle cerebral artery lesions were recanalized. No intraprocedural complications occurred. Seven in-hospital deaths occurred: stroke progression, 4; intracranial hemorrhage, 2; respiratory failure, 1. Seven patients had >or=4-point National Institutes of Health Stroke Scale improvement within 24 hours after the procedure, 6 had modified Rankin Score (mRS) <or=3 at discharge, and 4 had mRS <or=3 at 3 months. Overall, revascularization and improvement in clinical outcome were more likely to occur in women.
  
  
  CONCLUSIONS
  Feasibility of self-expanding stents for treatment of acute symptomatic intracranial occlusions is shown. For single-vessel lesions, stent placement with concomitant administration of IIb/IIIa inhibitors contributed to the achievement of recanalization rates exceeding those currently reported for other means of thrombolysis.
authors.affiliation: Department of Neurosurgery, University at Buffalo, Kaleida Health/Millard Gates Hospital, Buffalo,NY 14209, USA. elevy@buffns.com
authors.forename: E I
authors.initials: EI
authors.lastname: Levy
authors.forename: R
authors.initials: R
authors.lastname: Mehta
authors.forename: R
authors.initials: R
authors.lastname: Gupta
authors.forename: R A
authors.initials: RA
authors.lastname: Hanel
authors.forename: A J
authors.initials: AJ
authors.lastname: Chamczuk
authors.forename: D
authors.initials: D
authors.lastname: Fiorella
authors.forename: H H
authors.initials: HH
authors.lastname: Woo
authors.forename: F C
authors.initials: FC
authors.lastname: Albuquerque
authors.forename: T G
authors.initials: TG
authors.lastname: Jovin
authors.forename: M B
authors.initials: MB
authors.lastname: Horowitz
authors.forename: L N
authors.initials: LN
authors.lastname: Hopkins
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D005343:Fibrinolytic Agents; D019039:Platelet Glycoprotein GPIIb-IIIa Complex