In:
Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 58, No. 3 ( 2006-03-01), p. 458-463
Abstract:
In patients who are not candidates for intravenous tissue plasminogen activator, intra-arterial (IA) therapy is an alternative. Current recanalization rates are 50 to 60% for IA thrombolysis. Stent-assisted recanalization in the setting of acute stroke after failed thrombolysis may improve recanalization rates. METHODS: A retrospective analysis was performed of 19 patients treated at two institutions between July 2001 and March, 2005 with intracranial stenting of a vessel resistant to standard thrombolytic techniques. Demographics, clinical, and radiographic presentation and outcomes were studied. RESULTS: Thirteen men and six women with a median baseline National Institutes of Health Stroke Scale (NIHSS) score of 16 (range, 15–22) were included. Eight lesions were located at the internal carotid artery terminus, seven in the M1/M2 segment, and four in the basilar artery. Average time-to-treatment was 210 ± 160 minutes. Overall recanalization rate (Thrombolysis in Cerebral Infarction Grade 2 or 3) was 79%. There were six deaths: five due to progression of stroke and withdrawal of care at the family's request and one as the result of a delayed carotid injury after tracheostomy. One postoperative asymptomatic intracranial hemorrhage occurred without adverse affect on outcome. Median discharge NIHSS score of surviving patients was 5 (range, 2.5-11.5). Lesions at the internal carotid artery terminus (P & lt;0.009), older age (P & lt;0.003), and higher baseline NIHSS score (P & lt;0.009) were significant negative outcome predictors, as measured by & gt;3 modified Rankin scale score at discharge. CONCLUSION: Stent-assisted recanalization for acute stroke resulting from intracranial thrombotic occlusion is associated with a high recanalization rate and low intracranial hemorrhage rate. These initial results suggest that stenting may be an option for recalcitrant cerebral arterial occlusions.
Type of Medium:
Online Resource
ISSN:
0148-396X
,
1524-4040
DOI:
10.1227/01.NEU.0000199159.32210.E4
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2006
detail.hit.zdb_id:
1491894-8
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