OBJECTIVES: Stent-based techniques may allow rapid arterial recanalization in acute stroke. We present our experience using a self-expanding stent to achieve a transient bypass, and then as a thrombectomy device, with no permanent stent implantation, in acute stroke. MATERIALS AND METHODS: Six patients (mean age 55 years, range 35-71 years) presented with major ischemic stroke secondary to large vessel occlusion. Patients had a National Institutes of Health Stroke Scale score of >17, no intracerebral hemorrhage or early infarction, and poor collateral supply to the affected parenchyma. Within 6 hours of symptom onset, a stent (Solitaire, ev3, Irvine, CA, USA) was deployed across the entire occluded segment. Repeat angiogram was performed to evaluate the reconstituted flow. The balloon of the guide catheter was inflated for proximal carotid occlusion. The partially deployed stent was slowly pulled back (mechanical thrombectomy step) under continuous aspiration. Suction was repeated to ensure the aspiration of any clot remnants. RESULTS: In all the cases, complete recanalization (Thrombolysis in Myocardial Infarction Revascularization and Reperfusion Score of 3) was achieved in <60 minutes after femoral access, and a single thrombectomy attempt was sufficient to achieve clot removal. No stent was permanently implanted. Modified Rankin Scores were 0-2 in all patients at a mean 1-month follow-up. CONCLUSIONS: The presented approach allowed three desired effects: rapid endovascular revascularization, clot removal, and no need of leaving a permanent implant. In our preliminary experience this simple and rapid stent-based mechanical thrombectomy technique has had an unprecedented success rate.
OBJECTIVES: Stent-based techniques may allow rapid arterial recanalization in acute stroke. We present our experience using a self-expanding stent to achieve a transient bypass, and then as a thrombectomy device, with no permanent stent implantation, in acute stroke. MATERIALS AND METHODS: Six patients (mean age 55 years, range 35-71 years) presented with major ischemic stroke secondary to large vessel occlusion. Patients had a National Institutes of Health Stroke Scale score of >17, no intracerebral hemorrhage or early infarction, and poor collateral supply to the affected parenchyma. Within 6 hours of symptom onset, a stent (Solitaire, ev3, Irvine, CA, USA) was deployed across the entire occluded segment. Repeat angiogram was performed to evaluate the reconstituted flow. The balloon of the guide catheter was inflated for proximal carotid occlusion. The partially deployed stent was slowly pulled back (mechanical thrombectomy step) under continuous aspiration. Suction was repeated to ensure the aspiration of any clot remnants. RESULTS: In all the cases, complete recanalization (Thrombolysis in Myocardial Infarction Revascularization and Reperfusion Score of 3) was achieved in <60 minutes after femoral access, and a single thrombectomy attempt was sufficient to achieve clot removal. No stent was permanently implanted. Modified Rankin Scores were 0-2 in all patients at a mean 1-month follow-up. CONCLUSIONS: The presented approach allowed three desired effects: rapid endovascular revascularization, clot removal, and no need of leaving a permanent implant. In our preliminary experience this simple and rapid stent-based mechanical thrombectomy technique has had an unprecedented success rate.
Authors: Jens Fiehler; Michael Söderman; Francis Turjman; Philip M White; Søren Jacob Bakke; Salvatore Mangiafico; Rüdiger von Kummer; Mario Muto; Christophe Cognard; Jan Gralla Journal: Neuroradiology Date: 2012-09-05 Impact factor: 2.804