Background Early recanalization of occluded intracranial arteries in acute ischemic stroke is one of the most important factors for better clinical outcome. Recanalization with a self-expanding Wingspan stent, which can be deployed rapidly and safely, is an option for treating acute ischemic stroke when intravenous thrombolysis has failed or is contraindicated. We present the feasibility, efficacy and safety of recanalization with a wingspan stent for acute middle cerebral artery (MCA) occlusion.
Methods We collected 10 patients with acute MCA occlusion in whom recanalization was not achieved with a standard intravenous thrombolysis, or who were ineligible for intravenous thrombolysis or who presented after 3 h of symptom onset and the stenting could be completed within 8 h from stroke symptom onset. All 10 patients were treated with a self-expanding Wingspan stent. Recanalization results were assessed by thrombolysis in cerebral infarction (TICI) score of the target vessel after stenting. Neurological status was measured before and 7 days after stenting using the National Institutes of Health Stroke Scale (NIHSS). Procedure-related complications were assessed by a Vascular Neurologist. Functional outcome was evaluated at discharge according to the modified Rankin Scale (mRS).
Results Successful stent deployment and recanalization were achieved in all patients (TICI 2a:1, TICI 2b:3, TICI 3:6). The patients' mean NIHSS score on admission was 12.7 points with SD of 6.3 points (range 4–21). In all 10 patients, the occlusion site were located in the 1st segment of the MCA (M1, n=7, left:2, right:5) and 2nd segment of the MCA (M2, n=3, all: right). The mean time interval from stroke symptom onset to stenting was 34.8–76.3 min. No vessel perforations or dissections occurred in any patient. None of the patients had intracranial hemorrhage visible on follow-up CT. Nine patients improved on the NIHSS at 7 days after stenting. One patient did not change the NIHSS score even though the occluded artery was completely recanalized. At 7 days after recanalization, NIHSS score of all patients was 4.4–4.7 (median 4, range 0–13). At discharge, an mRS of three was achieved in all 10 patients and an mRS of two was achieved in seven patients (70%). No further ischemic events occurred within 90 days after stenting.
Conclusions This case series demonstrated that the self-expanding Wingspan stent can be used safely for acute MCA occlusion and can have a good clinical outcome if standard treatments are unavailable. Further, randomized trials will be needed to determine if stenting is associated with improved outcome.
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