Intracranial Stenting for Acute Ischemic Stroke Beyond 8 H
Intracranial Stenting for Acute Ischemic Stroke Beyond 8 H
Objective To report our experience with stent supported intracranial recanalization for acute ischemic stroke beyond 8 h of symptoms onset.
Background Acute ischemic stroke (AIS) therapy is often limited to an 8 h window using mechanical means. However, recent reports have shown delayed recanalization beyond 8 h might be a viable option in a subset of patients.
Methods A retrospective review was performed of our AIS database for patients who underwent stent supported intracranial recanalization beyond 8 h of symptom onset. Clinical and angiographic data were reviewed. Outcome was measured using modified Rankin Scale (mRS) scores at 30 and 90 days.
Results 12 patients (11 men and one woman) underwent delayed stenting for AIS. Mean age was 49 years (range 37–73) and mean National Institutes of Health Stroke Scale was 17 (range 8–29, median 15). Mean time from stroke onset to intervention was 66.1 h (range 10–168 h, median 46 h). 10 patients presented with a Thrombolysis in Myocardial Infarction (TIMI) score of 0 and the remaining two had a TIMI of 1. Recanalized vessels included: left middle cerebral artery (n=6), basilar trunk (n=2), vertebrobasilar junction (n=3) and internal carotid artery (ICA)-T (n=1). Four patients had prior attempts of embolectomy/thrombolysis using mechanical and chemical means. Stents used included: six balloon mounted stents, five Wingspan and one Enterprise self-expanding intracranial stent. Recanalization, defined as a TIMI score of 2 or more, was achieved in 11 patients. Two patients (17%) had intracranial hemorrhage. Thirty day mRS of ≤3 was achieved in six patients (50%). Seven patients (58%) had a 90 day mRS of ≤2.
Conclusion Stent supported intracranial recanalization is a safe and feasible approach in a selective group of patients presenting with acute ischemic stroke beyond 8 h of symptom onset.
Acute ischemic strokes (AIS) compromise up to 88% of strokes, and timely recanalization of these occlusions often leads to improved neurological outcome. Current recommendations for thrombolytic therapy for stroke are limited to 4.5 h for intravenous therapy or 8 h for intra-arterial treatment. Among the various approaches used to achieve intracranial recanalization, stent supported angioplasty has been retrospectively studied by various investigators as an alternative approach to the more established clot retrieval and thrombolytic strategies. Initial data from these studies show that stenting for AIS can be done with relative safety and efficacy. Further, all studies have been limited to a time window 8 h from stroke onset. However, it is reasonable in selected subgroups of patients to expect benefit from stent supported revascularization beyond the 8 h window. We here present our center experience in delayed recanalization beyond the 8 h window.
Abstract and Introduction
Abstract
Objective To report our experience with stent supported intracranial recanalization for acute ischemic stroke beyond 8 h of symptoms onset.
Background Acute ischemic stroke (AIS) therapy is often limited to an 8 h window using mechanical means. However, recent reports have shown delayed recanalization beyond 8 h might be a viable option in a subset of patients.
Methods A retrospective review was performed of our AIS database for patients who underwent stent supported intracranial recanalization beyond 8 h of symptom onset. Clinical and angiographic data were reviewed. Outcome was measured using modified Rankin Scale (mRS) scores at 30 and 90 days.
Results 12 patients (11 men and one woman) underwent delayed stenting for AIS. Mean age was 49 years (range 37–73) and mean National Institutes of Health Stroke Scale was 17 (range 8–29, median 15). Mean time from stroke onset to intervention was 66.1 h (range 10–168 h, median 46 h). 10 patients presented with a Thrombolysis in Myocardial Infarction (TIMI) score of 0 and the remaining two had a TIMI of 1. Recanalized vessels included: left middle cerebral artery (n=6), basilar trunk (n=2), vertebrobasilar junction (n=3) and internal carotid artery (ICA)-T (n=1). Four patients had prior attempts of embolectomy/thrombolysis using mechanical and chemical means. Stents used included: six balloon mounted stents, five Wingspan and one Enterprise self-expanding intracranial stent. Recanalization, defined as a TIMI score of 2 or more, was achieved in 11 patients. Two patients (17%) had intracranial hemorrhage. Thirty day mRS of ≤3 was achieved in six patients (50%). Seven patients (58%) had a 90 day mRS of ≤2.
Conclusion Stent supported intracranial recanalization is a safe and feasible approach in a selective group of patients presenting with acute ischemic stroke beyond 8 h of symptom onset.
Introduction
Acute ischemic strokes (AIS) compromise up to 88% of strokes, and timely recanalization of these occlusions often leads to improved neurological outcome. Current recommendations for thrombolytic therapy for stroke are limited to 4.5 h for intravenous therapy or 8 h for intra-arterial treatment. Among the various approaches used to achieve intracranial recanalization, stent supported angioplasty has been retrospectively studied by various investigators as an alternative approach to the more established clot retrieval and thrombolytic strategies. Initial data from these studies show that stenting for AIS can be done with relative safety and efficacy. Further, all studies have been limited to a time window 8 h from stroke onset. However, it is reasonable in selected subgroups of patients to expect benefit from stent supported revascularization beyond the 8 h window. We here present our center experience in delayed recanalization beyond the 8 h window.
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