Stent-Assisted Recanlization for Acute Ischemic Stroke

Abstract

Objective：Acute ischemic stroke attributable to major cerebral arteries occlusion is frequently associated with severe disability or death. Pharmacological or mechanical thrombolysis may achieve better results if the treatment can be performed within 3 hours of stroke onset. If failed thrombolysis, stent-assisted recanalization may improve recanalization rates. Methods : We reviewed retrospectively 9 patients with acute ischemic stroke resistant to standard thromolytic therapy, who received stent-assisted recanalization from January 2002 to December 2005. Dermographics, clinical, and radiographic presentation and outcomes were studied. Results : Five men and four women with a median baseline National Institutes of Health Stroke Scale (NIHSS) score of 15 (range, 12-20) were included. Five lesions were located in the extracranial internal carotid artery, two in the middle cerebral artery, one in the common carotid artery, and one in the mid-basilar artery. Mean time to treatment was 9.8±14.6 hours from symptom onset. All occlusions were successfully recanalized with thrombolysis and stent placement, and the stenotic ratio was reduced from 91% (pre-stenting) to 5% (post-stenting) on average. Procedure-related complications occurred in two patients (22%): distal embolism in one and subacute thrombotic occlusion in the other. NIHSS score at discharge showed significant improvement (P<0.05, Wilcoxon rank sum test). Conclusion : Emergency stent angioplasty for acute ischemic stroke with failed thrombolysis appears to have a high recanalization rate and to improve outcome in our retrospective study. This study reveals that emergency stent angioplasty could be considered as an optimal treatment for recalcitrant arterial occlusions.