J Korean Neurosurg Soc.  2017 Nov;60(6):627-634. 10.3340/jkns.2016.0707.003.

Mechanical Thrombectomy with Solitaire Stent Retrieval for Acute Cardioembolic Stroke

• Han H
• Choi H
• Cho KT
• Kim BC

• KMID: 2395781
• DOI: http://doi.org/10.3340/jkns.2016.0707.003

Abstract

OBJECTIVE
Few studies have reported the outcome of mechanical thrombectomy with Solitaire stent retrival (MTSR) in subtypes of acute ischemic stroke. The purpose of this study was to evaluate the efficacy and result of MTSR in acute cardioembolic stroke.
METHODS
Twenty consecutive patients with acute cardioembolic stroke were treated by MTSR. The angiographic outcome was assessed by thrombolysis in cerebral infarction (TICI) grade. TICI grade 2a, 2b, or 3 with a measurable thrombus that was retrieved was considered as a success when MTSR was performed in the site of primary vessel occlusion, and TICI grade 2b or 3 was considered as a success when final result was reported. Clinical and radiological results were compared between two groups divided on the basis of final results of MTSR. Persistent thrombus compression sign on angiogram was defined as a stenotic, tapered arterial lumen whenever temporary stenting was performed. The clinical outcomes were assessed by the modified Rankin Scale (mRS) at 3 months.
RESULTS
The failure rate of MTSR was 20% (4/20) and other modalities, such as permanent stenting, were needed. Final successful recanalization (TICI grade 2b or 3) was 80% when other treatments were included. The rate of good outcome (mRS≤2) was 35% at the 3-month follow-up. Failure of MTSR was significantly correlated with persistent thrombus compression sign (p=0.001).
CONCLUSION
Some cases of cardioembolic stroke are resistant to MTSR and may need other treatment modalities. Careful interpretation of angiogram may be helpful to the decision.

Keyword

Intracranial embolism; Mechanical thrombolysis

MeSH Terms

Cerebral Infarction
Follow-Up Studies
Humans
Intracranial Embolism
Mechanical Thrombolysis
Stents*
Stroke*
Thrombectomy*
Thrombosis

Figure

• 

  Fig. 1 Thrombus compression sign is defined as a tapered vascular stenosis when temporary stenting. (A and B) are angiograms of case 3. A: Initial angiogram shows left ICA terminus occlusion. B: Angiogram after temporary stenting shows a tapered stenosis which mimics true stenosis of left MCA. (C and D) are angiograms of case 13. C: Initial angiogram shows left M1 occlusion. D: Angiogram after temporary stenting reveals a pseudostenosis of left MCA. ICA: internal carotid artery, MCA: middle cerebral artery.

• 

  Fig. 2 Thrombus entrapment sign is defined as near occlusion or stenosis with non-tapered irregular lumen when temporary stenting is done. (A–C) are angiograms of case 2. A: Initial angiogram shows left ICA terminus occlusion. B: Angiogram after temporary stenting shows complete occlusion. Arrow points distal stent markers. C: Angiogram after MTSR reveals recanalization of left ICA. (D–F) are angiograms of case 17. D: Initial angiogram shows right ICA terminus occlusion. E: Angiogram after temporary stenting shows near occlusion with non-tapered irregular lumen. F: Angiogram after MTSR shows recanalization of right ICA. ICA: internal carotid artery, MTSR: mechanical thrombectomy with Solitaire stent retrival.

• 

  Fig. 3 Case of permanent stenting (case 20). A: Initial CTA shows left ICA terminus occlusion. B: Perfusion CT presents decreased CBF in the left hemisphere. C: Angiogram after temporary stenting reveals a tapered stenosis of left ICA terminus. D and E: Diffusion MR after 24 hours shows only minimal cerebral infarcts. F: CTA after 1 month reveals total lysis of the thrombus. Arrowheads points strut of the stent and arrow indicates distal markers of the stent. CTA: computed tomography angiography, ICA: internal carotid artery, CT: computed tomography, CBF: cerebral blood flow, MR: magnetic resonance.

Reference

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