Browse > Article
http://dx.doi.org/10.3340/jkns.2013.53.2.77

Critical Use of Balloon Angioplasty after Recanalization Failure with Retrievable Stent in Acute Cerebral Artery Occlusion  

Park, Jae Hyun (Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine)
Park, Sang Kyu (Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine)
Jang, Kyeong Sool (Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine)
Jang, Dong Kyu (Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine)
Han, Young Min (Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine)
Publication Information
Journal of Korean Neurosurgical Society / v.53, no.2, 2013 , pp. 77-82 More about this Journal
Abstract
Objective : Sudden major cerebral artery occlusion often resists recanalization with currently available techniques or can results in massive symptomatic intracranial hemorrhage (sICH) after thrombolytic therapy. The purpose of this study was to examine mechanical recanalization with a retrievable self-expanding stent and balloon in acute intracranial artery occlusions. Methods : Twenty-eight consecutive patients with acute intracranial artery occlusions were treated with a Solitaire retrievable stent. Balloon angioplasty was added if successful recanalization was not achieved after stent retrieval. The angiographic outcome was assessed by Thrombolysis in Cerebral Infarction (TICI) and the clinical outcomes were assessed by the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Results : At baseline, mean age was 69.4 years and mean initial NIHSS score was 12.5. A recanalization to TICI 2 or 3 was achieved in 24 patients (85%) after stent retrieval. Successful recanalization was achieved after additional balloon angioplasty in 4 patients. At 90-day follow-up, 24 patients (85%) had a NIHSS improvement of ${\geq}4$ and 17 patients (60%) had a good outcome (mRS ${\leq}2$). Although there was sICH, there was one death associated with the procedure. Conclusion : Mechanical thromboembolectomy with a retrievable stent followed by additional balloon angioplasty is a safe and effective first-line therapy for acute intracranial artery occlusions especially in case of unsuccessful recanalization after stent thrombectomy.
Keywords
Acute cerebral artery occlusion; Mechanical recanalization; Retrievable stent; Balloon angioplasty;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Broderick JP, Lu M, Kothari R, Levine SR, Lyden PD, Haley EC, et al. : Finding the most powerful measures of the effectiveness of tissue plasminogen activator in the NINDS tPA stroke trial. Stroke 31 : 2335-2341, 2000   DOI
2 Arnold M, Nedeltchev K, Mattle HP, Loher TJ, Stepper F, Schroth G, et al. : Intra-arterial thrombolysis in 24 consecutive patients with internal carotid artery T occlusions. J Neurol Neurosurg Psychiatry 74 : 739-742, 2003   DOI
3 Bose A, Henkes H, Alfke K, Reith W, Mayer TE, Berlis A, et al. : The Penumbra System : a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol 29 : 1409-1413, 2008   DOI
4 Brekenfeld C, Remonda L, Nedeltchev K, Arnold M, Mattle HP, Fischer U, et al. : Symptomatic intracranial haemorrhage after intra-arterial thrombolysis in acute ischaemic stroke : assessment of 294 patients treated with urokinase. J Neurol Neurosurg Psychiatry 78 : 280-285, 2007
5 Flint AC, Duckwiler GR, Budzik RF, Liebeskind DS, Smith WS; MERCI and Multi MERCI Writing Committee : Mechanical thrombectomy of intracranial internal carotid occlusion : pooled results of the MERCI and Multi MERCI Part I trials. Stroke 38 : 1274-1280, 2007   DOI
6 Castano C, Dorado L, Guerrero C, Millán M, Gomis M, Perez de la Ossa N, et al. : Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation : a pilot study. Stroke 41 : 1836-1840, 2010   DOI
7 Cohen JE, Gomori JM, Leker RR, Moscovici S, Ramirez-Denoriega F, Itshayek E : Recanalization with stent-based mechanical thrombectomy in anterior circulation major ischemic stroke. J Clin Neurosci 19 : 39-43, 2012   DOI
8 Eckert B, Koch C, Thomalla G, Kucinski T, Grzyska U, Roether J, et al. : Aggressive therapy with intravenous abciximab and intra-arterial rtPA and additional PTA/stenting improves clinical outcome in acute vertebrobasilar occlusion : combined local fibrinolysis and intravenous abciximab in acute vertebrobasilar stroke treatment (FAST) : results of a multicenter study. Stroke 36 : 1160-1165, 2005   DOI
9 Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, et al. : Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study : a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282 : 2003-2011, 1999   DOI
10 Furlan AJ. CVA : reducing the risk of a confused vascular analysis. The Feinberg lecture. Stroke 31 : 1451-1456, 2000   DOI
11 Gobin YP, Starkman S, Duckwiler GR, Grobelny T, Kidwell CS, Jahan R, et al. : MERCI 1 : a phase 1 study of Mechanical Embolus Removal in Cerebral Ischemia. Stroke 35 : 2848-2854, 2004   DOI
12 Kase CS, Furlan AJ, Wechsler LR, Higashida RT, Rowley HA, Hart RG, et al. : Cerebral hemorrhage after intra-arterial thrombolysis for ischemic stroke : the PROACT II trial. Neurology 57 : 1603-1610, 2001   DOI
13 Kim YS, Garami Z, Mikulik R, Molina CA, Alexandrov AV; CLOTBUST Collaborators : Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/middle cerebral artery occlusion and isolated middle cerebral artery occlusion. Stroke 36 : 869-871, 2005   DOI
14 Grunwald IQ, Walter S, Papanagiotou P, Krick C, Hartmann K, Dautermann A, et al. : Revascularization in acute ischaemic stroke using the penumbra system : the first single center experience. Eur J Neurol 16 : 1210-1216, 2009   DOI
15 Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, et al. : Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 34 : e109-e137, 2003   DOI
16 Koh JS, Lee SJ, Ryu CW, Kim HS : Safety and efficacy of mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke : a systematic review. Neurointervention 7 : 1-9, 2012   DOI
17 Kulcsar Z, Bonvin C, Pereira VM, Altrichter S, Yilmaz H, Lovblad KO, et al. : Penumbra system : a novel mechanical thrombectomy device for large-vessel occlusions in acute stroke. AJNR Am J Neuroradiol 31 : 628-633, 2010   DOI
18 Machi P, Lobotesis K, Maldonado IL, Costalat V, Vendrell JF, Riquelme C, et al. : Endovascular treatment of tandem occlusions of the anterior cerebral circulation with solitaire FR thrombectomy system. Initial experience. Eur J Radiol 81 : 3479-3484, 2012   DOI
19 Saver JL : Number needed to treat estimates incorporating effects over the entire range of clinical outcomes : novel derivation method and application to thrombolytic therapy for acute stroke. Arch Neurol 61 : 1066-1070, 2004
20 Papanagiotou P, Roth C, Walter S, Behnke S, Politi M, Fassbender K, et al. : Treatment of acute cerebral artery occlusion with a fully recoverable intracranial stent : a new technique. Circulation 121 : 2605-2606, 2010   DOI
21 Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP, et al. : Safety and efficacy of mechanical embolectomy in acute ischemic stroke : results of the MERCI trial. Stroke 36 : 1432-1438, 2005   DOI
22 Park H, Hwang GJ, Jin SC, Jung CK, Bang JS, Han MK, et al. : A retrievloweral thrombectomy technique with the Solitaire stent in a large cerebral artery occlusion. Acta Neurochir (Wien) 153 : 1625-1631, 2011   DOI
23 Rha JH, Saver JL : The impact of recanalization on ischemic stroke outcome : a meta-analysis. Stroke 38 : 967-973, 2007   DOI
24 Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, et al. : Mechanical thrombectomy for acute ischemic stroke : final results of the Multi MERCI trial. Stroke 39 : 1205-1212, 2008   DOI
25 Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 333 : 1581-1587, 1995   DOI
26 Tomsick T, Broderick J, Carrozella J, Khatri P, Hill M, Palesch Y, et al. : Revascularization results in the Interventional Management of Stroke II trial. AJNR Am J Neuroradiol 29 : 582-587, 2008   DOI
27 Wick MC, Klocker J, Jaschke W, Chemelli A : Endovascular popliteal thrombectomy using the self-expanding, retrievable Solitaire recanalization device. J Endovasc Ther 19 : 34-36, 2012   DOI
28 Zaidat OO, Suarez JI, Santillan C, Sunshine JL, Tarr RW, Paras VH, et al. : Response to intra-arterial and combined intravenous and intra-arterial thrombolytic therapy in patients with distal internal carotid artery occlusion. Stroke 33 : 1821-1826, 2002   DOI
29 Zangerle A, Kiechl S, Spiegel M, Furtner M, Knoflach M, Werner P, et al. : Recanalization after thrombolysis in stroke patients : predictors and prognostic implications. Neurology 68 : 39-44, 2007   DOI