Stent placement in acute cerebral artery occlusion: use of a self-expandable intracranial stent for acute stroke treatment.
OBJECTIVE
Stent placement has been applied in small case series as a rescue therapy in combination with different thrombolytic agents, percutaneous balloon angioplasty (PTA), and mechanical thromboembolectomy (MT) in acute stroke treatment. These studies report a considerable mortality and a high rate of intracranial hemorrhages when balloon-mounted stents were used. This study was performed to evaluate feasibility, efficacy, and safety of intracranial artery recanalization for acute ischemic stroke using a self-expandable stent.


METHODS
All patients treated with an intracranial stent for acute cerebral artery occlusion were included. Treatment comprised intraarterial thrombolysis, thromboaspiration, MT, PTA, and stent placement. Recanalization result was assessed by follow-up angiography immediately after stent placement. Complications related to the procedure and outcome at 3 months were assessed.


RESULTS
Twelve patients (median NIHSS 14, mean age 63 years) were treated with intracranial stents for acute ischemic stroke. Occlusions were located in the posterior vertebrobasilar circulation (n=6) and in the anterior circulation (n=6). Stent placement was feasible in all procedures and resulted in partial or complete recanalization (TIMI 2/3) in 92%. No vessel perforations, subarachnoid, or symptomatic intracerebral hemorrhages occurred. One dissection was found after thromboaspiration and PTA. Three patients (25%) had a good outcome (mRS 0 to 2), 3 (25%) a moderate outcome (mRS 3), and 6 (50%) a poor outcome (mRS 4 to 6). Mortality was 33.3%.


CONCLUSIONS
Intracranial placement of a self-expandable stent for acute ischemic stroke is feasible and seems to be safe to achieve sufficient recanalization.
Brekenfeld
Caspar
C
Institute of Interventional and Diagnostic Neuroradiology, University of Bern, Switzerland.
Schroth
Gerhard
G
Mattle
Heinrich P
HP
Do
Do-Dai
DD
Remonda
Luca
L
Mordasini
Pasquale
P
Arnold
Marcel
M
Nedeltchev
Krassen
K
Meier
Niklaus
N
Gralla
Jan
J
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000601:surgery*; D017128:Embolectomy; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome