Occlusion

BACKGROUND AND PURPOSE: Stent placement may be an effective and last resort method for recanalization of recalcitrant intracranial artery occlusion. The purpose of this study was to evaluate the safety and efficacy of a self-expanding stent for the recanalization of acute embolic or dissecting intracranial artery occlusion. MATERIALS AND METHODS: Nine patients (mean age, 66 years; NIHSS score, 10–23) with acute embolic (n 8) or dissecting occlusion (n 1) of the intracranial arteries (ICA terminus in 5, MCA in 3, and BA in 1) were treated with a recapturable self-expanding stent. The safety and efficacy of the stent for recanalization were evaluated retrospectively. RESULTS: The emboli were entrapped against the vessel wall by the stent, resulting in immediate recanalization (TIMI 2) in all embolic occlusions. The dissecting occlusion was recanalized completely (TIMI 3). Adjunctive thrombolytics (n 8, urokinase, 100,000–300,000 U) and/or GP IIb/IIIa antagonist (n 7, tirofiban, 0.5–1 mg) were administered intra-arterially, and the degree of recanalization further improved in 4 embolic occlusions (TIMI 3). Acute in-stent thrombosis occurred in 2 patients, who received only urokinase without GP IIb/IIIa antagonist. Both of the reoccluded arteries were reopened, by stent recapture in 1 and by intra-arterial administration of GP IIb/IIIa antagonist in the other. Recapture was attempted in 7 cases, of which there were 3 successful outcomes. There was 1 asymptomatic hemorrhagic conversion at the infarction site. The mean improvement of the NIHSS score between baseline and discharge was 12.3 (range, 3–22). CONCLUSIONS: Preliminary results of this study suggest that a self-expanding stent may be safe and efficient for recanalization of acute embolic or dissecting intracranial artery occlusion. ABBREVIATIONS: ACA anterior cerebral artery; BA basilar artery; Fx fracture; GP glyco-protein; hrs hours; ICA internal carotid artery; IV intravenous; M1 MCA M1 portion; M