Neurointervention.  2013 Sep;8(2):80-86. 10.5469/neuroint.2013.8.2.80.

Recanalization of Acute Intracranial Artery Occlusion Using Temporary Endovascular Bypass Technique

• Suh SH
• Lee KY
• Seo KD
• Lim SM
• Roh HG
• Kim BM

• KMID: 1784023
• DOI: http://doi.org/10.5469/neuroint.2013.8.2.80

Abstract

PURPOSE
The purpose of this study is to present our preliminary experience of the temporary endovascular bypass (TEB) technique using an Enterprise stent for recanalization of acute intracranial artery (IA) occlusion.
MATERIALS AND METHODS
Patients treated by TEB were enrolled in this retrospective study from January 2009 to May 2010. All the procedures consist of temporary partial deployment and subsequent retrieval of Enterprise stent, supplemented by intra-arterial infusion of urokinase (UK) and/or tirofiban. According to the thrombolysis in cerebral infarction (TICI) classification, recanalization was evaluated with initial and postprocedural angiography. Safety was evaluated related to the procedure and clinical outcomes were assessed by National Institute of Health Stroke Scale (NIHSS) score at discharge and modified Rankin scale (mRS) score at 3 months.
RESULTS
Eleven patients (median NIHSS 12.8, mean age 61.6 years, male: female = 8:3) with acute IA occlusion were treated with TEB. All the patients presented with TICI 0, and the occluded vessel was the middle cerebral artery (n=7), the basilar artery (n=1), and the distal ICA occlusion (n = 3). IV infusion of tissue plasminogen activator (tPA) was done in 4 patients and mechanical thrombolysis with intra-arterial UK was performed in 9. Recanalization was achieved in 73% (8 patients; TICI > or = 2). There were no procedure-related complications except for two asymptomatic intracranial hemorrhages. Improvement (> or = 4 points on the NIHSS) and good outcome (mRS < or =2) after 90 days was shown in six patients (55%). One patient died 6 days after procedure.
CONCLUSION
TEB may be a valuable treatment option in acute thromboembolic IA occlusion without stent implantation.

Keyword

Stroke; Recanalization; Temporary endovascular bypass; Retrievable stent

MeSH Terms

Angiography
Arteries
Basilar Artery
Cerebral Infarction
Female
Glycosaminoglycans
Humans
Infusions, Intra-Arterial
Intracranial Hemorrhages
Mechanical Thrombolysis
Middle Cerebral Artery
Retrospective Studies
Stents
Stroke
Tissue Plasminogen Activator
Tyrosine
Urokinase-Type Plasminogen Activator
Glycosaminoglycans
Tissue Plasminogen Activator
Tyrosine
Urokinase-Type Plasminogen Activator

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