title: Safety and efficacy of intracranial stenting for acute ischemic stroke beyond 8 h of symptom onset.
abstract: OBJECTIVE
  To report our experience with stent supported intracranial recanalization for acute ischemic stroke beyond 8 h of symptoms onset. Background Acute ischemic stroke (AIS) therapy is often limited to an 8 h window using mechanical means. However, recent reports have shown delayed recanalization beyond 8 h might be a viable option in a subset of patients.
  
  
  METHODS
  A retrospective review was performed of our AIS database for patients who underwent stent supported intracranial recanalization beyond 8 h of symptom onset. Clinical and angiographic data were reviewed. Outcome was measured using modified Rankin Scale (mRS) scores at 30 and 90 days.
  
  
  RESULTS
  12 patients (11 men and one woman) underwent delayed stenting for AIS. Mean age was 49 years (range 37-73) and mean National Institutes of Health Stroke Scale was 17 (range 8-29, median 15). Mean time from stroke onset to intervention was 66.1 h (range 10-168 h, median 46 h). 10 patients presented with a Thrombolysis in Myocardial Infarction (TIMI) score of 0 and the remaining two had a TIMI of 1. Recanalized vessels included: left middle cerebral artery (n=6), basilar trunk (n=2), vertebrobasilar junction (n=3) and internal carotid artery (ICA)-T (n=1). Four patients had prior attempts of embolectomy/thrombolysis using mechanical and chemical means. Stents used included: six balloon mounted stents, five Wingspan and one Enterprise self-expanding intracranial stent. Recanalization, defined as a TIMI score of 2 or more, was achieved in 11 patients. Two patients (17%) had intracranial hemorrhage. Thirty day mRS of ≤3 was achieved in six patients (50%). Seven patients (58%) had a 90 day mRS of ≤2.
  
  
  CONCLUSIONS
  Stent supported intracranial recanalization is a safe and feasible approach in a selective group of patients presenting with acute ischemic stroke beyond 8 h of symptom onset.
authors: Department of Neurology, Wayne State University, Detroit, Michigan, USA. axavier@med.wayne.edu
authors: Andrew R
authors: AR
authors: Xavier
authors: Ambooj
authors: A
authors: Tiwari
authors: Natasha
authors: N
authors: Purai
authors: Mahmoud
authors: M
authors: Rayes
authors: Paritosh
authors: P
authors: Pandey
authors: Amit
authors: A
authors: Kansara
authors: Sandra
authors: S
authors: Narayanan
authors: Seemant
authors: S
authors: Chaturvedi
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000601:surgery / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D017128:Embolectomy; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents / Q000145:classification; D020521:Stroke / Q000601:surgery / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery