J Stroke.  2016 Jan;18(1):96-101. 10.5853/jos.2015.01347.

Primary stent retrieval for acute intracranial large artery occlusion due to atherosclerotic disease

• Lee JS
• Hong JM
• Lee KS
• Suh HI
• Choi JW
• Kim SY

• KMID: 2223641
• DOI: http://doi.org/10.5853/jos.2015.01347

Abstract

BACKGROUND AND PURPOSE
The goal of stent retriever-based thrombectomy is removal of embolic clots in patients with intracranial large artery occlusion. However, outcomes of stent retrieval may differ between acute arterial occlusions due to intracranial atherosclerotic disease (IAD) and those due to embolism. This case series describes the outcomes of stent retriever-based thrombectomy and rescue treatments in 9 patients with IAD-related occlusion.
METHODS
Among patients who underwent endovascular treatment for acute intracranial large artery occlusion, those in whom stent retrieval was attempted as first-line treatment were included in this review. IAD was defined as significant fixed focal stenosis at the occlusion site, which was evident on final angiographic assessment or observed during endovascular treatment.
RESULTS
Median number of stent retriever passes was 2 (range, 1-3), and temporary bypass was seen in all patients. Immediate partial recanalization (arterial occlusive lesion grade 2-3) was observed in 7 patients. Immediate modified thrombolysis in cerebral infarction grade 2b-3 was seen in 6 patients, but the lesions often required rescue treatment due to reocclusion or flow insufficiency. In terms of rescue treatments, angioplasty and intra-arterial tirofiban infusion seemed to be effective.
CONCLUSIONS
Our findings suggest that stent retrieval can effectively remove thrombi from stenotic lesions and achieve partial recanalization despite the tendency toward reocclusion in most patients with IAD-related occlusion. Further research into the use of rescue treatments, such as tirofiban infusion and angioplasty, is warranted.

Keyword

Cerebral infarction; Thrombectomy; Mechanical thrombolysis; Intracranial arteriosclerosis; Intracranial embolism and thrombosis

MeSH Terms

Angioplasty
Arteries*
Cerebral Infarction
Constriction, Pathologic
Embolism
Humans
Intracranial Arteriosclerosis
Intracranial Embolism and Thrombosis
Mechanical Thrombolysis
Stents*
Thrombectomy