Single Comprehensive Stroke Center Research Articles

BACKGROUND In acute thromboembolic stroke, mechanical recanalization with stents may result in immediate flow restoration. In this single-center experience, we analiyze safety and efficacy data on the application of the thrombectomy devices. All cases of acute ischemic stroke in which a self-expandable fully retrievable intracranial stent was deployed as acute endovascular intervention were included in the analysis. Criteria for intervention were the onset of neurological symptoms a National Institute of Health Stroke Scale score ≥9 at presentation, large vessel occlusion stroke demonstrated by angio-CT, and failure of intravenous thrombolysis or exclusion criteria. MATERIALS AND METHODS: We performed an analysis of 72 consecutive patients with acute ischemic stroke treated with thrombectomy from April of 2010 to June of 2011. Forty patients were treated with the device (Solitaire, Trevo): 66 with anterior circulation stroke and 6 with posterior circulation stroke. Thirty two (44 %) patients received previously rtPA. Six patients had an occlusion of the basilar artery, forty had a middle cerebral artery occlusion, twenty had terminal carotid artery occlusions and six extracranial carotid occlusion. Successful recanalization results were assessed by follow-up angiography immediately after the procedure (TIMI II-III). We divided them in two groups, good (90 days mRankin score ≤3) or bad neurological outcome and find out variables associated with it. RESULTS: The mean age was 66.5 years (range, 32-86 years; 53% men). The median NIHSS score at presentation was 18 (range, 6-26). Recanalization (TIMI 2-3) was achieved in (67%). Symptomatic hemorrhage occurred in 8%. Procedural complications occurred in 2 patients, vessel perforation without clinical consequences. Ninety-day mortality was 23%; good 90-day functional outcome (mRS, ≤ 2) was achieved by 39%. Good neurologic outcomes (mRankin ≤3 at 90 days) were more frequent (83% versus 18%), and mortality rates were lower (5 % versus 18 %) with successful compared with unsuccessful recanalization . Besides good or bad prognosis of patients aren’t associated with severe carotid stenosis or occlusion (carotid T or tandem occlusion) . Neither sex nor other epidemiologic datas were indicator of bad prognosis. CONCLUSIONS: Efficacy and safety of thrombectomy and translation to improved patient outcome is sufficiently established. New thrombectomy devices might be used in case of unsuccessful recanalization as failure of complete recanalization is associated with poor outcome.

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