Cohen José E, Gomori John M, Leker Ronen R, Eichel Roni, Arkadir David, Itshayek Eyal
Department of Neurosurgery, Hadassah-Hebrew University Medical Center Jerusalem, Israel.
Neurol Res. 2011 Mar;33(2):214-9. doi: 10.1179/1743132810Y.0000000015.
Stent-based techniques may allow rapid arterial recanalization in acute stroke. We present our experience using a self-expanding stent to achieve a transient bypass, and then as a thrombectomy device, with no permanent stent implantation, in acute stroke.
Six patients (mean age 55 years, range 35-71 years) presented with major ischemic stroke secondary to large vessel occlusion. Patients had a National Institutes of Health Stroke Scale score of >17, no intracerebral hemorrhage or early infarction, and poor collateral supply to the affected parenchyma. Within 6 hours of symptom onset, a stent (Solitaire, ev3, Irvine, CA, USA) was deployed across the entire occluded segment. Repeat angiogram was performed to evaluate the reconstituted flow. The balloon of the guide catheter was inflated for proximal carotid occlusion. The partially deployed stent was slowly pulled back (mechanical thrombectomy step) under continuous aspiration. Suction was repeated to ensure the aspiration of any clot remnants.
In all the cases, complete recanalization (Thrombolysis in Myocardial Infarction Revascularization and Reperfusion Score of 3) was achieved in <60 minutes after femoral access, and a single thrombectomy attempt was sufficient to achieve clot removal. No stent was permanently implanted. Modified Rankin Scores were 0-2 in all patients at a mean 1-month follow-up.
The presented approach allowed three desired effects: rapid endovascular revascularization, clot removal, and no need of leaving a permanent implant. In our preliminary experience this simple and rapid stent-based mechanical thrombectomy technique has had an unprecedented success rate.
基于支架的技术可能有助于急性卒中时动脉的快速再通。我们介绍了使用自膨式支架实现临时搭桥，然后作为血栓清除装置，且不进行永久性支架植入治疗急性卒中的经验。
6例患者（平均年龄55岁，范围35 - 71岁）因大血管闭塞继发严重缺血性卒中。患者美国国立卫生研究院卒中量表评分>17，无脑出血或早期梗死，且患侧实质的侧支供血差。在症状发作6小时内，将一枚支架（Solitaire，ev3，美国加利福尼亚州欧文市）跨过整个闭塞节段展开。进行重复血管造影以评估再灌注血流。将引导导管的球囊充气以实现颈内动脉近端闭塞。在持续抽吸的情况下，将部分展开的支架缓慢回撤（机械取栓步骤）。重复抽吸以确保清除所有血栓残余物残渣。
所有病例在股动脉穿刺后<60分钟均实现了完全再通（心肌梗死溶栓再灌注分级评分为3级），且单次取栓尝试就足以清除血栓。未进行永久性支架植入。在平均1个月的随访中，所有患者的改良Rankin量表评分为0 - 2分。
所介绍的方法实现了三个预期效果：快速血管内再通、清除血栓以及无需留置永久性植入物。根据我们的初步经验，这种基于支架的简单快速机械取栓技术取得了前所未有的成功率。
