title: Recanalization with stent-based mechanical thrombectomy in anterior circulation major ischemic stroke.
abstract: We report the use of a self-expanding stent as a thrombectomy device in 17 patients (mean age 64.3 years) with major ischemic stroke secondary to large vessel occlusion. The patients had a mean National Institutes of Health Stroke Scale (NIHSS) score of >12, no cerebral hemorrhage or early infarction signs that affected more than 1/3 of the endangered territory, and an insufficient collateral supply. Within 8 hours of symptom onset, a stent (Solitaire; ev3, Irvine, CA, USA) was deployed across the occluded segment (endovascular bypass step). A repeat angiogram was performed to evaluate reconstituted flow. The guide-catheter balloon was inflated for proximal carotid occlusion. The partially deployed stent was slowly pulled back (mechanical thrombectomy step) under continuous aspiration. Complete recanalization (TIMI grade 3 flow) was achieved in fewer than 66 minutes after femoral access in all patients, with complete clot removal in a mean of two thrombectomy attempts. No stent was permanently implanted. Two patients developed asymptomatic hemorrhagic transformation (11.8%). Two patients presented post-recanalization parenchymal hemorrhage (11.8%); one suffered an intracerebral and intraventricular hemorrhage 12 hours after a successful and uneventful procedure and died 10 days later. The modified Rankin Scale scores were 0 to 2 in 15 patients (88.2%) and 3 in one patient (5.9%) at 1 month. In our preliminary experience, rapid stent-based mechanical thrombectomy has had unprecedented success.
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Ein-Kerem, PO Box 12000, Jerusalem 91120, Israel. jcohenns@yahoo.com
authors.forename: José E
authors.initials: JE
authors.lastname: Cohen
authors.forename: John M
authors.initials: JM
authors.lastname: Gomori
authors.forename: Ronen R
authors.initials: RR
authors.lastname: Leker
authors.forename: Samuel
authors.initials: S
authors.lastname: Moscovici
authors.forename: Fernando
authors.initials: F
authors.lastname: Ramirez-Denoriega
authors.forename: Eyal
authors.initials: E
authors.lastname: Itshayek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000295:instrumentation / Q000379:methods*; D020520:Brain Infarction / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D002545:Brain Ischemia / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D015607:Stents / Q000592:standards* / Q000706:statistics & numerical data