Stent-Assisted Mechanical Recanalization for Treatment of Acute Intracerebral Artery Occlusions

Abstract

Background and Purpose-The purpose of this study was to demonstrate a new approach to the use of a self-expanding stent in the treatment of acute ischemic stroke. Methods-Twenty-two consecutive patients with acute intracerebral artery occlusions were treated with a self-expandable intracranial stent, which was withdrawn in its unfolded state. For this technique, we used the Solitaire AB/FR, which is the only intracranial stent that is fully recoverable. Eight patients had an occlusion of the basilar artery, 12 had a middle cerebral artery occlusion, and 2 had terminal carotid artery occlusions; 6 of these had to be treated first for an acute occlusion originating in the internal carotid artery. Recanalization results were assessed by follow-up angiography immediately after the procedure. Neurologic status was evaluated before and after treatment (90-day follow-up) according to the National Institutes of Health Stroke Scale and modified Rankin scale. Results-Successful revascularization was achieved in 20 of 22 (90.9%) patients (thrombolysis in cerebral infarction[TICI] 2a/b and 3), a TICI 3 state was accomplished in 12 patients, and partial recanalization or slow distal branch filling with filling of more than two-thirds of the vessel territory was achieved in 8 patients (TICI 2b). There was immediate flow restoration in 21 of 22 (95.4%) cases after deployment of the device. The stent was removed in its unfolded state in all patients. The mean time from stroke symptom onset to recanalization was 277 minutes, with a standard deviation of 118 minutes. Mean National Institutes of Health Stroke Scale score on admission was 19.4, with a standard deviation of 5.7. Almost two-thirds of the patients (63.6%) improved by Ͼ10 points on the National Institutes of Health Stroke Scale at discharge, and 50% showed a modified Rankin scale score of Յ2 at 90 days (59% with a modified Rankin scale Յ3). Mortality was 18.1%. In 1 case, an asymptomatic intracranial hemorrhage was detected on control computed tomography, and 2 patients had a symptomatic intracranial hemorrhage. Conclusion-Withdrawal of an unfolded, fully recoverable, intracranial stent yielded very promising angiographic and clinical results. It combines the advantages of prompt flow restoration and mechanical thrombectomy. (Stroke.

Technical Feasibility and Application of Mechanical Thrombectomy with the Solitaire FR Revascularization Device in Acute Basilar Artery Occlusion

“…[10][11][12][15][16][17] acute BAOs in their series of 50 patients with large vessel occlusion stroke. Successful recanalization (defined as TICI 3) was achieved in 81% (13/16), with a mean of 2.1 passes.…”

“…10 However, most studies concerning the efficacy of stent retrievers have been performed in large vessel occlusions of the anterior circulation, including only a few or single cases of BAO. [10][11][12][13][14][15][16][17] Furthermore, in the posterior circulation, proximal balloon occlusion for flow reversal during retrieval is not applicable. Therefore, the risk of distal thromboembolic events is potentially increased.…”

Double Solitaire Mechanical Thrombectomy in Acute Stroke: Effective Rescue Strategy for Refractory Artery Occlusions?

“…Standard first-line MT with a single SR was performed either by using a balloon-guide catheter or a DAC as described previously. [11][12][13] The Solitaire device was used in all MT procedures either as a single device or for the double SR technique. The sizes of the Solitaire devices used included Solitaire AB, 3 ϫ 20 mm, and Solitaire FR or Solitaire Two, 4 ϫ 20 mm and 6 ϫ 30 mm.…”

Evaluation of an Intravenous-Endovascular Strategy in Patients with Acute Proximal Middle Cerebral Artery Occlusion

“…Recent reports have also demonstrated equally encouraging results in terms of the efficacy (ie, recanalization) and safety with this device. [22][23][24] The major limitation of this study was the absence of patient randomization between IVT and IES groups, which may have biased our results. However, these 2 groups consisted of consecutive cases comparable in regard to classic prognostic factors, and the results were based on a multivariable analysis with an adjustment on confounding factors.…”