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Case series
Balloon-mounted stents for acute intracranial large vessel occlusion secondary to presumed atherosclerotic disease: evolution in an era of supple intermediate catheters
  1. Bradley A Gross1,
  2. Shashvat M Desai2,
  3. Gregory Walker3,
  4. Brian Thomas Jankowitz4,
  5. Ashutosh Jadhav5,
  6. Tudor G Jovin5
  1. 1 Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2 Departments of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3 Department of Neurology, University of British Columbia, New Westminister, British Columbia, Canada
  4. 4 Department of Neurosurgery, UPMC, Pittsburgh, Pennsylvania, USA
  5. 5 Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Bradley A Gross, Neurosurgery, University of Pittsburgh, Pittsburgh, PA 15213, USA; grossb2{at}upmc.edu

Abstract

Introduction Treatment of acute large vessel occlusion (LVO) stroke secondary to intracranial atherosclerotic disease (ICAD) is more nuanced with disparate and infrequently reported outcomes. The deployment of balloon-mounted stents presents an expedient approach with renewed feasibility in the modern era of supple intermediate catheters.

Methods A prospectively maintained endovascular stroke database was searched for patients undergoing intracranial stenting with balloon-mounted stents for acute LVO. Demographic, angiographic, and clinical data were extracted to determine procedural technique and success, measured both angiographically and clinically.

Results Sixty patients underwent stenting for acute LVO secondary to ICAD. Mean presenting National Institutes of Health Stroke Scale (NIHSS) score was 18 and 62% of treated sites were in the posterior circulation. Cases were performed under IV conscious sedation unless the patient was already intubated. Successful recanalization was achieved in 93% of cases (Thrombolysis in Cerebral Infarction (TICI) grade 2b in 48% and TICI grade 3 in 45%). Mean improvement in NIHSS score on post-procedure day 1 was 3.4. Good outcome (modified Rankin Scale score 0–2) at 3 months was 34% and the mortality rate was 34%. The rate of peri-procedural symptomatic hemorrhage was 8% and the rate of acute/subacute stent thrombosis was 7%. In this small cohort, patient age, sex, presenting NIHSS, comorbidities, smoking, tissue plasminogen activator administration, and stent location were not significant predictors of recanalization or good outcome.

Conclusion Treatment of acute LVO stroke with balloon-mounted stents for ICAD has reperfusion rates and clinical outcomes comparable to thrombectomy, with higher rates of hemorrhage and mortality. Because stent placement was performed after attempted thrombectomy, a trial of primary stenting versus thrombectomy should be considered in patients suspected of underlying ICAD.

  • atherosclerosis
  • balloon
  • catheter
  • stent
  • stroke
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Footnotes

  • Contributors Conception and design: BAG, AJ, TGJ. Drafting the article: BAG, AJ, TGJ. Acquisition of data/data analysis: BAG, SMD, GW. Reviewed and revised article prior to submission: all authors. Study supervision: TGJ.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BTJ: Consultant, Medtronic. BAG: Consultant, Microvention. TGJ: Consultant, Stryker Neurovascular (PI DAWN-unpaid); Ownership interest: Anaconda; Advisory Board/Investor: FreeOx Biotech, Advisory Board/Investor; Route92, Advisory Board/Investor; Blockade Medical, Consultant; Honoraria: Cerenovus.

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

  • Patient consent for publication Not required.

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