Introduction Rescue stenting is used more and more in stroke cases with large-vessel-occlusion or medium-vessel-occlusion refractory to mechanical thrombectomy. The pEGASUS-stent(Phenox) represents a device which is equipped with a hydrophilic polymer coating(HPC) with antithrombogenic properties. The coating allows for implantation under single antiplatelet therapy, thus possibly reducing the risk of bleeding in acute stroke cases.
Case History A 79-year-old woman was rushed to emergency room due to left-sided hemiparesis and National-Institutes-of-Health-Stroke-Scale(NIHSS) of 14. Computed-tomography-image showed an occlusion of right posterior communicating artery(PCOM). Intravenous thrombolysis was initiated. Due to relevant clinical deficits an additional mechanical thrombectomy-maneuver was decided (figure 1A+B).
There was a persisting stenosis following the first (figure 1C) and re-occlusion following the second thrombectomy-maneuver (figure 1D). After exclusion of intracranial hemorrhage with a flat-detector-CT, an interdisciplinary decision was made in favor of rescue-stenting of re-occluded PCOM. Considering the fact that the patient was already under medication with Edoxaban (transient ischemic attacks in the past) the pEGASUS-HPC-stent (3.5x15 mm) was chosen. Prior to stenting 300mg of Aspirin were injected intravenously. After angioplasty with NeuroSpeed-balloon-catheter 2x8 mm (Acandis) the stent could be successfully deployed (figure 1E) and complete reperfusion was achieved (figure 1F). Monotherapy with Aspirin 100mg/d was started and during 17 days of hospital stay no new neurological deficits or ischemic events occurred. After follow-up-MRI and CT-Angiography at day 3 showed no extensive infarction and confirmed patency of the stent, dual antiplatelet therapy with Aspirin(100mg/d) and Clopidogrel(75mg/d) was started. The patient was discharged from hospital with an NIHSS of 2.
Disclosure of Interest Nothing to disclose
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