J Korean Soc Radiol.  2011 Jul;65(1):41-51. 10.3348/jksr.2011.65.1.41.

Mechanical Recanalization of Cerebral Artery Embolic Occlusion Using a Self-Expanding Stent: Experimental Analysis in Canine Model

• Choi JW
• Kim SJ
• Lee DH
• Suh DC

• KMID: 1443492
• DOI: http://doi.org/10.3348/jksr.2011.65.1.41

Abstract

PURPOSE
To evaluate the feasibility of a self-expanding stent for acute embolic occlusion, and recanalization mechanism by histologic examination.
MATERIALS AND METHODS
Five mongrel dogs were used as study subjects. Each vertebral artery was occluded, and a self-expanding stent was used for recanalization. We evaluated the technical success rate for the placement of the stent to the targeted vessel, the recanalization rate, and residual stenosis. We obtained two specimens of the stented vertebral arteries for histologic evaluation.
RESULTS
One dog died of an unknown cause during the induction of anesthesia. In two dogs, only one side of the vertebral artery was used, whereas both vertebral arteries were used in the remaining dogs. A total of six vertebral arteries were successfully occluded. The technical success rate for stenting without complication was 66.7%. The immediate recanalization rate after stenting was 100%. The residual stenosis was 35.6 +/- 18.6%. On microscopic examination, the stent concentrically displaced the clot and the clot was captured between the stent mesh and arterial wall.
CONCLUSION
Self-expanding stents were effective in revascularizing the cerebrovascular embolic occlusion. The self-expanding stent seemed to achieve recanalization by pushing the clot to the arterial wall and capturing the clot between the stent mesh and arterial wall.

MeSH Terms

Anesthesia
Animals
Cerebral Arteries
Constriction, Pathologic
Dogs
Glycosaminoglycans
Ischemia
Models, Animal
Stents
Stroke
Thromboembolism
Thrombolytic Therapy
Vertebral Artery
Glycosaminoglycans

Figure

• 

  Fig. 1 A baseline anteroposterior (AP) view of a left vertebral arteriogram using digital subtraction angiography (DSA) shows normal blood flow and anatomy (A). After the radio-opaque clot (arrows) was successfully delivered into the cervical segment of left vertebral artery (B), the AP view of the left vertebral arteriogram using DSA shows the complete occlusion of the cervical segment of left vertebral artery by the clot (C). AP view without DSA shows the self-expanding stent (arrow heads) completely covering the clot (D). A follow-up angiogram shows flow with an AOL score of 2 through the stented segment of the left vertebral artery (E). Note.-AOL = Arterial Occlusive Lesion

• 

  Fig. 2 Left vertebral angiogram using DSA shows complete occlusion of the artery (A). During the passage of the microdelivery catheter (arrowhead) over the microguidewire, fragmentation of the clot occurred (long arrows) (B). Although the stent (short arrows) is placed successfully to cover the whole length of the clot, distal migration of the fragmented clot (large arrow) is observed at distal branch (C).

• 

  Fig. 3 A microscopic image (× 40) of the distal end of a stented segment of the right vertebral artery of the fourth dog shows good apposition of the stent strut to the arterial wall. Two areas of the denuded intima (open arrows) are noted and compared with intact intima (A). A microscopic image (× 40) of the stented segment of the occlusion by clot shows the capture of the clot between the stent strut and arterial wall (B). However, one strut cannot appose to the clot completely (short arrow) and the protruded portion of clot though the wide stent mesh (long arrows) is seen.

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