Article Text

other Versions

PDF
Safety and efficacy of intracranial stenting for acute ischemic stroke beyond 8 h of symptom onset
  1. Andrew R Xavier1,3,
  2. Ambooj Tiwari1,
  3. Natasha Purai2,
  4. Mahmoud Rayes1,
  5. Paritosh Pandey3,
  6. Amit Kansara1,
  7. Sandra Narayanan1,3,
  8. Seemant Chaturvedi1
  1. 1Department of Neurology, Wayne State University, Detroit, Michigan, USA
  2. 2Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA
  3. 3Department of Neurological Surgery, Wayne State University, Detroit, Michigan, USA
  1. Correspondence to Dr A Xavier, Department of Neurological Surgery, Wayne State University, 930 Professional Office Building, 4610 John R, Detroit, MI 48225, USA; axavier{at}med.wayne.edu

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.

Statistics from Altmetric.com

Footnotes

  • Competing interests None.

  • Ethics approval The data collection and analysis in this study was performed with the approval of the Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.