Intracranial stent placement for recanalization of acute cerebrovascular occlusion in 32 patients

Abstract

Background and purpose: Stents have been reported as an option for improvement of the recanalization rate in AIS. The authors have also used intracranial stents in failed cases of IAT with pharmacologic and mechanical methods since 2004. We retrospectively reviewed our cases of intracranial stent use for IAT of AIS for recanalization and as a rescue procedure for iatrogenic intracranial vascular dissection during IAT.

Materials and methods: Thirty-two patients, who were diagnosed with AIS, were treated with intracranial stents (28 balloon-mounted and 7 self-expandable stents) at our neurovascular center between April 2004 and December 2008. The stent use for all 32 patients was the final attempt to recanalize occluded vessels after various trials of pharmacologic or mechanical thrombolysis or to treat iatrogenic vascular dissection.

Results: Among the 32 patients, immediate poststenting angiographic recanalization was achieved in 100% with TIMI/TICI 2 (15 of 32 lesions, 46.9%) or TIMI/TICI 3 (17 of 32 lesions, 53.1%). However, complication rates were also high. Major symptomatic intracerebral hemorrhage (1 case of procedural symptomatic hemorrhage and 3 cases of delayed symptomatic hemorrhage) occurred in 4 (12.5%); intracranial vascular dissection, in 4 (12.5%); extracranial vascular dissection, in 3 (9.4%); immediate IST, in 4 (12.5%); subacute (within 1 week) IST, in 2; late (>1 week) IST, in 1, and 1 case of in-stent restenosis occurred twice (at 5 and 17 months).

Conclusions: Intracranial stent placement for AIS management has an excellent recanalization rate. However, it is associated with high complication risks as our series showed. We believe that the decision to treat AIS with intracranial stent placement should be made after careful consideration of potential benefits and risks.

Fig 1.

A 39-year-old man with left hemiparesis and dysarthria was transferred to our institution for IAT. The initial NIHSS score was 15. IV-tPA was not given because of delayed arrival (270 minutes). A, Initial right carotid angiogram, demonstrates proximal M1 occlusion. B, Recanalization (TIMI/TICI 3) is achieved after deploying a balloon-mounted stent (2.25 × 12 mm, Micro-Driver, Medtronic). The postoperative NIHSS score was 4.

Fig 2.

A 77-year-old woman with acute left M1 occlusion. The initial NIHSS score was 17. IV-tPA was given. A, Initial left carotid angiogram demonstrates proximal M1 occlusion. B, A 2.75 × 12 mm FlexMaster (Abbott Laboratories) stent is deployed across the focal area of occlusion, and partial recanalization (TIMI/TICI 2A) is achieved. C, CT 7 hours after IAT demonstrates a large basal ganglia hematoma. The patient died with massive cerebral swelling.