scholarly journals Intracranial Stenting for Acute Ischemic Stroke

10.5772/26232 ◽  
2012 ◽  
Author(s):  
Ahmad Khaldi ◽  
J. Mocco
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Stenting

Acute intracranial stenting with mechanical thrombectomy is safe and efficacious in patients diagnosed with underlying intracranial atherosclerotic disease

2021 ◽  
pp. 159101992110394
Author(s):  
Ameer E Hassan ◽  
Victor M Ringheanu ◽  
Laurie Preston ◽  
Wondwossen G Tekle ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Intracranial Stenting ◽  
Intracranial Atherosclerotic Disease

Objective To investigate whether significant differences exist in recanalization rates and primary outcomes between patients who undergo mechanical thrombectomy alone versus those who undergo mechanical thrombectomy with acute intracranial stenting. Methods Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2020, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage, mortality rate at discharge, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score and modified Rankin Scale were examined. The outcomes between patients receiving acute intracranial stenting + mechanical thrombectomy and patients that underwent mechanical thrombectomy alone were compared. Results There were a total of 420 acute ischemic stroke patients who met criteria for the study (average age 70.6 ± 13.01 years; 46.9% were women). Analysis of 46 patients from the acute stenting + mechanical thrombectomy group (average age 70.34 ± 13.75 years; 37.0% were women), and 374 patients from the mechanical thrombectomy alone group (average age 70.64 ± 12.92 years; 48.1% were women). Four patients (8.7%) in the acute stenting + mechanical thrombectomy group experienced intracerebral hemorrhage versus 45 patients (12.0%) in the mechanical thrombectomy alone group ( p = 0.506); no significant increases were noted in the median length of stay (7 vs 8 days; p = 0.208), rates of modified thrombolysis in cerebral infarction 2B-3 recanalization ( p = 0.758), or good modified Rankin Scale scores ( p = 0.806). Conclusion Acute intracranial stenting in addition to mechanical thrombectomy was not associated with an increase in overall length of stay, intracerebral hemorrhage rates, or any change in discharge modified Rankin Scale. Further research is required to determine whether mechanical thrombectomy and acute intracranial stenting in acute ischemic stroke patients is unsafe.

Rescue Intracranial Stenting in acute Ischemic Stroke v1

2021 ◽  
Author(s):  
Minh Thang Le ◽  
Chi Cuong Tran ◽  
Luu Giang Nguyen ◽  
Dao Nhat Huy Nguyen ◽  
Minh Tuan Ngo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Demographic History ◽  
Positive Likelihood Ratio ◽  
Large Vessel ◽  
3 Tesla ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Intracranial Stenting ◽  
Poor Outcome

Abstract Background In acute ischemic stroke (AIS) caused by intracranial large vessel occlusion, rescue intracranial stenting (RIS) has been recently a treatment option to achieve recanalization in patients with the failure of mechanical thrombectomy (MT). Nevertheless, there are few studies supporting this beneficial treatment in two cerebral circulations. We aimed to analyze whether the use of RIS would improve prognosis “non-poor” of patients at 3 months. Methods and Findings This was a interventional, single-arm study in patients with AIS who were treated with rescue stenting at Can Tho S.I.S hospital. Inclusion criteria consisted of: evidence of intracranial large vessel occlusion, absence of intracranial hemorrhage and severe stenosis or reocclusion after MT. Tandem lesion, loss to follow-up after discharge and a severe or fatal combined illness before AIS were excluded. The primary outcome was the “non-poor” outcome rate at 3 months and postprocedural symptomatic intracerebral hemorrhage (sICH). The study is registered with ClinicalTrials.gov, NCT04986774.Between August 2019 and May 2021, 85 eligible patients were comprised of 82 (96.5%) successful recanalization and 4 (4.7%) sICH. “Non-poor” outcome comprising of good (mRS 0 - ≤ 2) and fair (mRS 3). “Non-poor” outcome at 3 months occurred 47 (55.3%), in which there were 35 (41.2%) good outcome. DAPT was associated with new infarcts (RR = 0.1; 95%CI 0.01 - 0.7, NNT = 2) and sICH (RR = 0.1; 95%CI 0.01 - 0.9; NNT = 2). MRI 3 Tesla evaluated diagnostic occlusive lesions with sensitivity (Se) = 98.5%, positive Likelihood Ratio (LR+) = 3.5. The pc-ASPECTS < 6 points was associated with poor outcome (RR = 2.1, 95% CI 1.2- 3.7). Many predictors from demographic, history, time onset, dysphagia, imaging of MRI 3 Tesla, preprocedure, procedure and postprocedure were demonstrated the influence on poor outcome after RIS significantly (all RR > 1, all p < 0.05). The main limitations of the study was conducted in a single center, these results from clinical symptoms to imaging of MRI 3 Tesla could not only be influenced by selection bias but also not generalize to other countries in Asia. Conclusions The RISIS trial suggests that RIS could be an important alternative and additional treatment afterfailureMT despite low proportion of postprocedural sICH. Trial registration Clinicaltrials.gov, Identifier:NCT04986774.

Intracranial Stenting as a Rescue Therapy for Acute Ischemic Stroke After Stentriever Thrombectomy Failure

2018 ◽  
Vol 120 ◽  
pp. e181-e187 ◽  
Author(s):  
Tengfei Zhou ◽  
Tianxiao Li ◽  
Liangfu Zhu ◽  
Meiyun Wang ◽  
Yingkun He ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Rescue Therapy ◽  
Intracranial Stenting

Safety and efficacy of intracranial stenting for acute ischemic stroke beyond 8 h of symptom onset

2011 ◽  
Vol 4 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Andrew R Xavier ◽  
Ambooj Tiwari ◽  
Natasha Purai ◽  
Mahmoud Rayes ◽  
Paritosh Pandey ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Intracranial Stenting ◽  
Safety And Efficacy

MIDDLE CEREBRAL ARTERY STENTING FOR ACUTE ISCHEMIC STROKE AFTER UNSUCCESSFUL MERCI RETRIEVAL

Neurosurgery ◽  
2007 ◽  
Vol 60 (4) ◽  
pp. 701-706 ◽  
Author(s):  
Eric Sauvageau ◽  
Rodney M. Samuelson ◽  
Elad I. Levy ◽  
Alison M. Jeziorski ◽  
Ricky A. Mehta ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Cerebral Artery ◽  
National Institutes Of Health ◽  
High Rate ◽  
Vessel Occlusion ◽  
Intracranial Stenting ◽  
Acute Cerebral Ischemia

Abstract OBJECTIVE Intracranial stenting has been used in the treatment of ischemic stroke caused by acute intracranial vessel occlusion after unsuccessful recanalization with the Merci retriever. We describe our early experience with this technique. METHODS Patients who had intra-arterial therapy for acute ischemic stroke with concomitant use of the retriever between February 1, 2005 and May 2, 2006 were identified from our endovascular database. Cases in which recanalization was not achieved with the retriever and in which stenting was attempted as a secondary means of mechanical recanalization were retrospectively reviewed. RESULTS Ten patients with unsuccessful Merci retrieval underwent intracranial stenting. The average admission National Institutes of Health Stroke Scale score was 16.4. Occlusions were located in the middle cerebral artery (six extended into M2 branches). Four patients received intra-arterial reteplase (two prestent, one preretriever and poststent, and one poststent). Eptifibatide was administered immediately before stenting in every patient. Successful recanalization (thrombolysis in myocardial infarction 2 or 3) was achieved in nine out of 10 patients. Complications included an extradural perforation with arteriovenous fistula. Six patients had intracranial hematoma and/or subarachnoid hemorrhage; there were four deaths. The six surviving patients experienced at least a 6-point National Institutes of Health Stroke Scale improvement at discharge, although only one had a modified Rankin Scale score of 2 or less. CONCLUSION Angiographic recanalization has been associated with improvement in clinical outcome after acute cerebral ischemia. Recanalization is not always achieved using the Merci retriever. We found that stenting after unsuccessful Merci retrieval resulted in a high rate of angiographic success. Further research into refining indications and optimizing outcome is warranted.

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