Levy E I, Sauvageau E, Hanel R A, Parikh R, Hopkins L N
Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14209, USA.
AJNR Am J Neuroradiol. 2006 Nov-Dec;27(10):2069-72.
Despite advances in mechanical thrombolysis for acute stroke, recanalization rates remain approximately 50%-60%. Technologic improvements allowed safe intracranial delivery of stents. To study the feasibility of stent-assisted recanalization for acute stroke, we deployed self-expanding or balloon-mounted stents in 2- to 3.5-mm canine vessels acutely occluded with clot emboli.
Six mongrel dogs were placed under general anesthesia. A guiding catheter was placed in the distal vertebral artery or an external carotid artery branch. A 7 x 3 mm (length x diameter) soft or hard clot was injected into the catheter and allowed to embolize distally; 20 vessels were successfully occluded. After systemic heparin anticoagulation, recanalization with a self-expanding stent was attempted in 11 vessels (5 occluded with soft clot; 6, with hard clot). Balloon-mounted stents were placed in an attempt to revascularize 9 vessels (4 occluded with soft clot; 5, with hard clot). Vessel recanalization was assessed as the primary end point. Side-branch occlusion and stent-induced vasospasm were also assessed.
Thrombolysis in Myocardial Infarction/Thrombolysis in Cerebral Infarction flow for 11 vessels treated with self-expanding stents versus 9 treated with balloon-mounted stents was as follows: grade 3, 91% of vessels versus 78% of vessels; grade 2, 0% versus 11%; grade 1, 9% versus 0%; grade 0, 0% versus 11%. Lower rates of spasm and side-branch occlusion were noticed with self-expanding stents. Grade 2/3 flow was achieved in 18/20 vessels (90%).
Excellent recanalization was demonstrated with both stents. Recanalization in self-expanding stents was achieved without pre- or post-balloon dilation. Stents may prove to be a useful adjunct for intra-arterial acute stroke treatment.
尽管急性卒中的机械溶栓技术取得了进展，但再通率仍保持在约50%-60%。技术的改进使得支架能够安全地颅内输送。为研究支架辅助再通治疗急性卒中的可行性，我们在2至3.5毫米的犬类血管中部署了自膨式或球囊扩张式支架，这些血管被血栓栓子急性阻塞。
6只杂种犬接受全身麻醉。将引导导管置于椎动脉远端或颈外动脉分支。将一个7×3毫米（长×直径）的软或硬血栓注入导管，并使其向远端栓塞；成功阻塞20条血管。全身肝素抗凝后，尝试用自膨式支架对11条血管进行再通（5条被软血栓阻塞；6条被硬血栓阻塞）。放置球囊扩张式支架以对9条血管进行血管再通（4条被软血栓阻塞；5条被硬血栓阻塞）。血管再通被评估为主要终点。还评估了分支血管阻塞和支架诱导的血管痉挛。
自膨式支架治疗的11条血管与球囊扩张式支架治疗的9条血管的心肌梗死溶栓/脑梗死溶栓血流情况如下：3级，分别为91%的血管和78%的血管；2级，分别为0%和11%；1级，分别为9%和0%；0级,分别为0%和11%。自膨式支架的痉挛和分支血管阻塞发生率较低。18/20条血管（90%）实现了2/3级血流。
两种支架均显示出良好的再通效果。自膨式支架无需球囊预扩张或后扩张即可实现再通。支架可能被证明是动脉内急性卒中治疗的有用辅助手段。
