Clinical analysis of 16 cases of remedial stent placement after mechanical thrombectomy for acute cerebral infarction

Abstract

Objective To explore the efficacy and safety of the remedial stent implantation after mechanical thrombectomy for acute cerebral infarction. Methods From October 2014 to December 2018, the clinical data of 16 patients with acute cerebral infarction who could not maintain forward blood flow after mechanical thrombectomy in 985 Hospital of joint service support force of PLA were analyzed retrospectively.To analyze the score of National Institutes of Health Stroke Scale (NIHSS), degree of vascular recanalization after operation thrombolysis incerebral infarction(TICI) classificatio, mechanical thrombolytic number, postoperative vascular reocclusion rate, incidence of intracranial hemorrhage, NIHSS score 1 week later, good clinical result after 90 days(improved Rankin scale, mRs= 0-2) and other indicators. Results After mechanical embolectomy, 16 stents were implanted (15 of them were Solitaire stents, 1 of them was Apollo stents), 12 patients with TICI=3, and 4 patients with TICI=2b.The average number of times of mechanical thrombectomy was(3.25±1.09). Balloon expansion was performed before stent placement in 7 patients with limited stenosis.The time from the onset to the reperfusion was(10.96 ± 3.24) hours. Computed tomography angiography(CTA) was reexamined 24 hours after operation, showing vascular of 3 cases were reocclusion and 3 cases occured intracranial hemorrhage(all less than 10 ml). In 2 cases of decompressive osteotomy, NIHSS score was improved from preoperative (24.25±4.58) points to postoperative (7.44±5.09) points.After 90 days, 10 patients had a good prognosis (mRs ≤ 2) and 1 patient died (pulmonary infection). Conclusion After mechanical thrombectomy of acute cerebral infarction, if there is severe stenosis or forward blood flow can not be maintained, use the Solitaire stent or other stent to remedy the placement, with fewer complications and better clinical effect. Key words: Acute ischemic stroke; Stent implantation; Remedial treatment; Mechanical thrombectomy