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Self-expanding stent for recanalization of acute embolic or dissecting intracranial artery occlusion

Authors
 S.H. Suh  ;  B.M. Kim  ;  H.G. Roh  ;  K.-Y. Lee  ;  S.I. Park  ;  D.I. Kim  ;  D.J. Kim  ;  H.S. Nam  ;  H.S. Choi 
Citation
 AMERICAN JOURNAL OF NEURORADIOLOGY, Vol.31(3) : 459-463, 2010 
Journal Title
 AMERICAN JOURNAL OF NEURORADIOLOGY 
ISSN
 0195-6108 
Issue Date
2010
MeSH
Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting/diagnostic imaging ; Aneurysm, Dissecting/therapy ; Arterial Occlusive Diseases/diagnostic imaging ; Arterial Occlusive Diseases/therapy ; Cerebral Angiography ; Cerebral Revascularization/methods* ; Cerebrovascular Disorders/diagnostic imaging* ; Cerebrovascular Disorders/therapy* ; Female ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/therapy ; Intracranial Embolism/diagnostic imaging ; Intracranial Embolism/therapy ; Retrospective Studies ; Stents*/adverse effects ; Stroke/diagnostic imaging ; Stroke/therapy ; Treatment Outcome
Abstract
BACKGROUND AND PURPOSE: Stent placement may be an effective and last resort method for recanalization of recalcitrant intracranial artery occlusion. The purpose of this study was to evaluate the safety and efficacy of a self-expanding stent for the recanalization of acute embolic or dissecting intracranial artery occlusion. MATERIALS AND METHODS: Nine patients (mean age, 66 years; NIHSS score, 10-23) with acute embolic (n = 8) or dissecting occlusion (n = 1) of the intracranial arteries (ICA terminus in 5, MCA in 3, and BA in 1) were treated with a recapturable self-expanding stent. The safety and efficacy of the stent for recanalization were evaluated retrospectively. RESULTS: The emboli were entrapped against the vessel wall by the stent, resulting in immediate recanalization (TIMI 2) in all embolic occlusions. The dissecting occlusion was recanalized completely (TIMI 3). Adjunctive thrombolytics (n = 8, urokinase, 100,000-300,000 U) and/or GP IIb/IIIa antagonist (n = 7, tirofiban, 0.5-1 mg) were administered intra-arterially, and the degree of recanalization further improved in 4 embolic occlusions (TIMI 3). Acute in-stent thrombosis occurred in 2 patients, who received only urokinase without GP IIb/IIIa antagonist. Both of the reoccluded arteries were reopened, by stent recapture in 1 and by intra-arterial administration of GP IIb/IIIa antagonist in the other. Recapture was attempted in 7 cases, of which there were 3 successful outcomes. There was 1 asymptomatic hemorrhagic conversion at the infarction site. The mean improvement of the NIHSS score between baseline and discharge was 12.3 (range, 3-22). CONCLUSIONS: Preliminary results of this study suggest that a self-expanding stent may be safe and efficient for recanalization of acute embolic or dissecting intracranial artery occlusion
Files in This Item:
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DOI
10.3174/ajnr.A1865
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Choi, Hyun Seok(최현석)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/100757
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