Primary Stent Retrieval for Acute Intracranial Large Artery Occlusion Due to Atherosclerotic Disease
Open Access
- 31 January 2016
- journal article
- Published by Korean Stroke Society in Journal of Stroke
- Vol. 18 (1), 96-101
- https://doi.org/10.5853/jos.2015.01347
Abstract
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. 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. 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. 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.Keywords
Funding Information
- National Research Foundation of Korea (2014R1A1A1008249)
- Ministry of Education
This publication has 18 references indexed in Scilit:
- Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in StrokeThe New England Journal of Medicine, 2015
- Thrombectomy within 8 Hours after Symptom Onset in Ischemic StrokeThe New England Journal of Medicine, 2015
- Randomized Assessment of Rapid Endovascular Treatment of Ischemic StrokeThe New England Journal of Medicine, 2015
- Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging SelectionThe New England Journal of Medicine, 2015
- A Randomized Trial of Intraarterial Treatment for Acute Ischemic StrokeThe New England Journal of Medicine, 2015
- Research on Intracranial Atherosclerosis from the East and West: Why Are the Results Different?Journal of Stroke, 2014
- Low Rates of Acute Recanalization With Intravenous Recombinant Tissue Plasminogen Activator in Ischemic StrokeStroke, 2010
- Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic StrokeThe New England Journal of Medicine, 2008
- Immediate reocclusion following a successful thrombolysis in acute stroke: A pilot studyNeurology, 2003
- Tissue Plasminogen Activator for Acute Ischemic StrokeThe New England Journal of Medicine, 1995