Stent for temporary endovascular bypass and thrombectomy in major ischemic stroke.
Endovascular techniques for acute stroke have evolved from a pharmacological to a mechanical approach. We report illustrative cases of successful anterior circulation recanalization in patients with large arterial occlusions, using a stent-based technique to perform arterial recanalization and thrombectomy, without permanent stent implantation. Four patients (mean age 59 years), presented with National Institutes of Health Stroke Scale (NIHSS) scores of 18 to 24, from 2 hours to 6 hours after stroke onset, with middle cerebral artery (MCA), MCA branch, internal carotid artery (ICA) terminus, or tandem ICA-MCA occlusions. A closed-cell stent was temporarily inserted to achieve temporary endovascular bypass, and then used as a thrombectomy device during withdrawal. Rapid and complete recanalization with successful thrombectomy was achieved in all patients within 28 minutes to 52 minutes. One week after treatment patients achieved NIHSS scores of 2 to 5, with no hemorrhagic complications. This approach allowed rapid endovascular revascularization and thrombectomy, without permanent stent implant. Stent-based thrombectomy devices may become a valuable tool in the management of acute ischemic stroke.
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel. jcohenns@yahoo.com
José E
JE
Cohen
John M
JM
Gomori
Ronen R
RR
Leker
David
D
Arkadir
Eyal
E
Itshayek
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000601:surgery; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000295:instrumentation / Q000379:methods; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods*; D013995:Time; D016896:Treatment Outcome