J Korean Neurosurg Soc.  2013 Feb;53(2):77-82. 10.3340/jkns.2013.53.2.77.

Critical Use of Balloon Angioplasty after Recanalization Failure with Retrievable Stent in Acute Cerebral Artery Occlusion

Affiliations
  • 1Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea. skparkns@gmail.com

Abstract


OBJECTIVE
Sudden major cerebral artery occlusion often resists recanalization with currently available techniques or can results in massive symptomatic intracranial hemorrhage (sICH) after thrombolytic therapy. The purpose of this study was to examine mechanical recanalization with a retrievable self-expanding stent and balloon in acute intracranial artery occlusions.
METHODS
Twenty-eight consecutive patients with acute intracranial artery occlusions were treated with a Solitaire retrievable stent. Balloon angioplasty was added if successful recanalization was not achieved after stent retrieval. The angiographic outcome was assessed by Thrombolysis in Cerebral Infarction (TICI) and the clinical outcomes were assessed by the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS).
RESULTS
At baseline, mean age was 69.4 years and mean initial NIHSS score was 12.5. A recanalization to TICI 2 or 3 was achieved in 24 patients (85%) after stent retrieval. Successful recanalization was achieved after additional balloon angioplasty in 4 patients. At 90-day follow-up, 24 patients (85%) had a NIHSS improvement of > or =4 and 17 patients (60%) had a good outcome (mRS < or =2). Although there was sICH, there was one death associated with the procedure.
CONCLUSION
Mechanical thromboembolectomy with a retrievable stent followed by additional balloon angioplasty is a safe and effective first-line therapy for acute intracranial artery occlusions especially in case of unsuccessful recanalization after stent thrombectomy.

Keyword

Acute cerebral artery occlusion; Mechanical recanalization; Retrievable stent; Balloon angioplasty

MeSH Terms

Angioplasty, Balloon
Arteries
Cerebral Arteries
Cerebral Infarction
Follow-Up Studies
Humans
Intracranial Hemorrhages
National Institutes of Health (U.S.)
Stents
Stroke
Thrombectomy
Thrombolytic Therapy

Figure

  • Fig. 1 A case illustration for combination of thromboembolectomy with stent retrieval and balloon angioplasty of a 59-year-old male presenting with motor weakness of the left arm and leg. Right internal carotid artery (ICA) angiography before recanalization (A) reveals an acute thromboembolic occlusion of the right distal ICA. Right ICA angiography after recanalization shows severe stenosis of the distal ICA-M1 segment after stent deployment (B) and M1 segment occlusion even after repeating stent retrieval (C). After angioplasty with Gateway balloon (2.0×15 mm) (D), angiography shows successful recanalization (TICI grade 3) (E). TICI : Thrombolysis in Cerebral Infarction.

  • Fig. 2 Comparison of National Institutes of Health Stroke Scale (NIHSS) scores before and after recanalization.


Cited by  1 articles

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Jung Hwa Seo, Hae Woong Jeong, Sung Tae Kim, Eun-Gyu Kim
Neurointervention. 2015;10(1):22-27.    doi: 10.5469/neuroint.2015.10.1.22.


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