Revascularization of symptomatic subacute cerebrovascular occlusions with a self-expanding intracranial stent system.
OBJECTIVE
In some patients, collateral circulation may preserve the viability of brain parenchyma distal to an intracranial arterial occlusion for hours or days after the presenting event. These patients may be good candidates for revascularization, even when they present outside of the accepted 6-hour time window for stroke intervention.


METHODS
Three patients were revascularized with the Wingspan stent system (Boston Scientific/Target, Fremont, CA) after presenting with subacute occlusions of intracranial arteries and progressive ischemic symptoms despite maximal medical therapy. All pre- and postprocedural imaging data and clinical records were reviewed.


RESULTS
Three patients (mean age, 64 years; 2 women, 1 man) presented with symptomatic intracranial occlusions of the internal carotid artery (n = 2) and vertebrobasilar system (n = 1). All 3 patients presented more than 6 hours after symptom onset, and no intravenous or intra-arterial thrombolysis had been instituted. In all cases, despite supportive medical therapy (anticoagulation and antiplatelet therapy and induced hypertension), the patients continued to demonstrate progressive ischemia, both clinically and on diffusion magnetic resonance imaging. All patients were successfully revascularized without periprocedural complications and improved clinically after revascularization.


CONCLUSIONS
In selected patients, symptomatic subacute occlusions of intracranial arteries may be revascularized using the Wingspan stent system.
Kelly
Michael E
ME
Division of Neurosurgery, Royal University Hospital, Saskatoon, Canada.
Turner
Raymond D
RD
Moskowitz
Shaye I
SI
Gonugunta
Vivek R
VR
Rasmussen
Peter A
PA
Masaryk
Thomas J
TJ
Fiorella
David
D
D000368:Aged; D002340:Carotid Artery Diseases / Q000601:surgery; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000295:instrumentation*; D002561:Cerebrovascular Disorders / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D020521:Stroke / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000295:instrumentation