Department of Diagnostic and Interventional Neuroradiology, Saarland University Hospital, Homburg, Germany.
Stroke. 2010 Nov;41(11):2559-67. doi: 10.1161/STROKEAHA.110.592071. Epub 2010 Oct 14.
The purpose of this study was to demonstrate a new approach to the use of a self-expanding stent in the treatment of acute ischemic stroke.
Twenty-two consecutive patients with acute intracerebral artery occlusions were treated with a self-expandable intracranial stent, which was withdrawn in its unfolded state. For this technique, we used the Solitaire AB/FR, which is the only intracranial stent that is fully recoverable. Eight patients had an occlusion of the basilar artery, 12 had a middle cerebral artery occlusion, and 2 had terminal carotid artery occlusions; 6 of these had to be treated first for an acute occlusion originating in the internal carotid artery. Recanalization results were assessed by follow-up angiography immediately after the procedure. Neurologic status was evaluated before and after treatment (90-day follow-up) according to the National Institutes of Health Stroke Scale and modified Rankin scale.
Successful revascularization was achieved in 20 of 22 (90.9%) patients (thrombolysis in cerebral infarction [TICI] 2a/b and 3), a TICI 3 state was accomplished in 12 patients, and partial recanalization or slow distal branch filling with filling of more than two-thirds of the vessel territory was achieved in 8 patients (TICI 2b). There was immediate flow restoration in 21 of 22 (95.4%) cases after deployment of the device. The stent was removed in its unfolded state in all patients. The mean time from stroke symptom onset to recanalization was 277 minutes, with a standard deviation of 118 minutes. Mean National Institutes of Health Stroke Scale score on admission was 19.4, with a standard deviation of 5.7. Almost two-thirds of the patients (63.6%) improved by > 10 points on the National Institutes of Health Stroke Scale at discharge, and 50% showed a modified Rankin scale score of ≤ 2 at 90 days (59% with a modified Rankin scale ≤ 3). Mortality was 18.1%. In 1 case, an asymptomatic intracranial hemorrhage was detected on control computed tomography, and 2 patients had a symptomatic intracranial hemorrhage.
Withdrawal of an unfolded, fully recoverable, intracranial stent yielded very promising angiographic and clinical results. It combines the advantages of prompt flow restoration and mechanical thrombectomy.
本研究旨在展示一种使用自膨式支架治疗急性缺血性卒中的新方法。
22 例连续急性颅内动脉闭塞患者采用自膨式颅内支架治疗，支架在未展开状态下撤出。对于该技术，我们使用 Solitaire AB/FR，这是唯一可完全回收的颅内支架。8 例基底动脉闭塞，12 例大脑中动脉闭塞，2 例颈内动脉终末段闭塞；其中 6 例需要先处理起源于颈内动脉的急性闭塞。通过术后立即的随访血管造影评估再通结果。神经功能状态根据国立卫生研究院卒中量表和改良 Rankin 量表在治疗前后（90 天随访）进行评估。
22 例患者中有 20 例（90.9%）成功再通（血栓切除术溶栓程度 [TICI] 2a/b 和 3），12 例达到 TICI 3 状态，8 例实现部分再通或缓慢远端分支充盈，充盈程度超过血管区域的三分之二（TICI 2b）。22 例患者中有 21 例（95.4%）在支架植入后立即恢复血流。所有患者的支架均以未展开状态取出。从卒中症状发作到再通的平均时间为 277 分钟，标准差为 118 分钟。入院时平均国立卫生研究院卒中量表评分为 19.4，标准差为 5.7。将近三分之二的患者（63.6%）出院时国立卫生研究院卒中量表评分提高超过 10 分，50%在 90 天时改良 Rankin 量表评分≤2（59%改良 Rankin 量表≤3）。死亡率为 18.1%。1 例患者在控制 CT 上发现无症状性颅内出血，2 例患者发生症状性颅内出血。
展开的、完全可回收的颅内支架的撤出取得了非常有前景的血管造影和临床结果。它结合了迅速恢复血流和机械血栓切除术的优势。
