Abstract
Recanalization of acute large artery occlusions is a strong predictor of good outcome. The development of thrombectomy devices resulted in a significant improvement in recanalization rates compared to thrombolytics alone. However, clinical trials and registries with these thrombectomy devices in acute ischemic stroke (AIS) have shown recanalization rates in the range of 40–81%. The last decade has seen the development of nickel titanium self-expandable stents (SES). These stents, in contrast to balloon-mounted stents, allow better navigability and deployment in tortuous vessels and therefore are optimal for the cerebral circulation. SES were initially used for stent-assisted coil embolization of intracranial aneurysms and for treatment of intracranial stenosis. However, a few authors have recently reported feasibility of deployment of SES in AIS. The use of these devices yielded higher recanalization rates compared to traditional thrombectomy devices. Encouraged by these results, retrievable SES systems have been recently used in AIS. These devices offer the advantage of resheathing and retrieving of the stent even after full deployment. Some of these stents can also be detached in case permanent stent placement is needed. Retrievable SES are being used in Europe and currently tested in clinical trials in the United States. We review the recent literature in the use of stents for the treatment of AIS secondary to large vessel occlusion.
Highlights
Recanalization is a strong predictor of good outcome in cerebral ischemia secondary to large vessel occlusion (Nogueira et al, 2009a)
Good clinical outcome was seen in 25% of patients. Recanalization rates with these devices are variable and some lesions like carotid terminus or basilar artery occlusions have a poor response to alternative therapies like thrombolytics (IMS Study Investigators, 2004)
After failure to recanalize the occluded vessel with intraarterial (IA) thrombolysis and balloon angioplasty, a balloon-mounted stent was successfully deployed resulting in TIMI-3 flow
Summary
Recanalization is a strong predictor of good outcome in cerebral ischemia secondary to large vessel occlusion (Nogueira et al, 2009a). The other FDA approved device for mechanical thrombectomy, the Penumbra System, showed an 81% recanalization rate (thrombolysis in myocardial infarction, TIMI 2/3; Penumbra Pivotal Stroke Trial Investigators, 2009). HISTORICAL PERSPECTIVE Phatouros et al (1999) reported the first endovascular stenting of an acutely occluded basilar artery with excellent angiographic results. In their case report, after failure to recanalize the occluded vessel with intraarterial (IA) thrombolysis and balloon angioplasty, a balloon-mounted stent was successfully deployed resulting in TIMI-3 flow. After failure to recanalize the occluded vessel with intraarterial (IA) thrombolysis and balloon angioplasty, a balloon-mounted stent was successfully deployed resulting in TIMI-3 flow. All the stents used up to this point are coronary balloon-mounted stents
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