Use of a vascular reconstruction device to salvage acute ischemic occlusions refractory to traditional endovascular recanalization methods.
OBJECTIVE
Acute revascularization has been associated with improved stroke outcomes. The Prolyse in Acute Cerebral Thromboembolism (PROACT II) trial achieved recanalization rates of 66%. The Multi Mechanical Embolus Removal in Cerebral Ischemia (Multi MERCI) trial achieved recanalization in 70% of patients. However, these interventional tools are not always successful. The Enterprise vascular reconstruction device was recently introduced for treatment of cerebral aneurysms previously untreatable with endovascular techniques. The authors evaluated a multicenter experience using this stent as a salvage revascularization tool for acute stroke treatment.


METHODS
Four medical centers participated in a retrospective review of endovascularly treated patients with acute stroke for cases treated with the Enterprise stent after routine interventions had been unsuccessful. Data collected included preprocedure information, intraprocedure findings, and outcomes.


RESULTS
Twenty patients with acute stroke (mean age 61.6 +/- 22 years) were treated with the Enterprise stent. Ten patients received intravenous recombinant tissue plasminogen activator before catheter intervention, without improvement. Intraarterial interventions attempted unsuccessfully before Enterprise deployment included the Merci retriever (12 patients), angioplasty (7 patients), glycoprotein IIb-IIIa inhibitor administration (12 patients), intraarterial nitroglycerin (1 patient), Wingspan stent deployment (3 patients), and Xpert stent deployment (1 patient). The mean preintervention National Institutes of Health Stroke Scale (NIHSS) score was 17 +/- 6 (median 17). All patients presented with a Thrombolysis in Myocardial Infarction (TIMI) score of 0 or 1. Revascularization was achieved in all patients (75% with a TIMI score of 3, 25% with a TIMI score of 2). Improvement (> or = 4 points on the NIHSS) was documented in 75% of patients. Mean NIHSS improvement from intervention to discharge was 8 +/- 7 points (median 9 points).


CONCLUSIONS
These preliminary data suggest a potential benefit to the use of the Enterprise stent when routine intervention methods fail.
Mocco
J
J
Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
Hanel
Ricardo A
RA
Sharma
Jitendra
J
Hauck
Erik F
EF
Snyder
Kenneth V
KV
Natarajan
Sabareesh K
SK
Linfante
Italo
I
Siddiqui
Adnan H
AH
Hopkins
L Nelson
LN
Boulos
Alan S
AS
Levy
Elad I
EI
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy / Q000601:surgery*; D002548:Cerebral Revascularization / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000188:drug therapy / Q000601:surgery*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator