title: Combined interventional stroke therapy using intracranial stent and local intraarterial thrombolysis (LIT).
abstract: BACKGROUND
  Supported by results of the ECASS III study, intravenous rt-PA thrombolysis is considered a standard therapy for acute stroke within 4.5 h. Still under debate is the use of a more aggressive treatment as that of local intraarterial thrombolysis (LIT) or combining intravenous administration of recombinant tissue plasminogen activator (rt-PA) followed by LIT (bridging concept). Mechanical thrombus removal devices and effective flow achievement by stenting are reported to increase the recanalization rate and patient outcome. Newer reports showed the use of intracranial stents as the latest trend-setting technique. A combined approach hereby appears to achieve the best results consisting of pharmacologic thrombolysis, manual aspiration devices and stenting. We employed a novel removable stent as a new approach in acute stroke, aiming to make the intraarterial thrombolysis through an enhanced thrombus contact surface more effective and to reduce the effective revascularisation time with the possibility of stent removal after re-opening the occluded vessel.
  
  
  METHODS
  We describe four cases with acute stroke in the anterior and posterior circulation using a newer self-expandable removable stent (Solitaire™ AB) combined with LIT performed in the 'bridging technique', occasionally supported by additional thrombus aspiration.
  
  
  RESULTS
  In all cases, we directly achieved after stenting an effective revascularization with fast recanalization time when using stent implantation first. Stenting was always technically successful without complications.
  
  
  CONCLUSIONS
  The easy handling of a removable stent in stent-assisted revascularization combined with thrombolysis (i.v./i.a.) is a newly described technique for acute stroke treatment, which join immediate mechanical recanalization, postulated improved thrombolysis and the possibility of stent removing.
authors.affiliation: Department of Radiology, University of Cologne, Cologne, Germany. Mirko.seifert@gmx.de
authors.forename: Mirko
authors.initials: M
authors.lastname: Seifert
authors.forename: Alexander
authors.initials: A
authors.lastname: Ahlbrecht
authors.forename: Christian
authors.initials: C
authors.lastname: Dohmen
authors.forename: Elmar
authors.initials: E
authors.lastname: Spuentrup
authors.forename: Walter
authors.initials: W
authors.lastname: Moeller-Hartmann
mesh_terms: D000368:Aged; D002404:Catheterization / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D015607:Stents; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator