Unbound MEDLINE

Balloon-expandable stent placement in patients with immediate reocclusion after initial successful thrombolysis of acute middle cerebral arterial obstruction.

Abstract

We present the results of our approach for treating 12 consecutive cases of acute middle cerebral artery (MCA) stroke by performing balloon-expandable stent (BES) placement after immediate reocclusion due to the underlying stenosis after intra-arterial thrombolysis (IAT). We retrospectively reviewed the clinical outcomes of 12 patients with acute MCA stroke who underwent recanalization by BES placement in an underlying stenosis after IAT. The time to treatment, urokinase dose, duration of the procedure, recanalization rates and symptomatic hemorrhage were analyzed. Clinical outcome measures were assessed on admission and at discharge (the National Institutes of Health stroke scores [NIHSS]) as well as three months after treatment (modified Rankin scales [mRS]). The median NIHSS score on admission was 8.6. Four patients received IV rtPA. The median time from symptom onset to IAT was 236 minutes and the median duration of IAT was 62 minutes. The median dose of urokinase was 140,000 units. Initial recanalization after stent deployment (thrombolysis in cerebral ischemia attack grade of II or III) was achieved in all patients. Two patients died in the hospital due to aspiration pneumonia during medical management. In two patients, in-stent reocclusion occurred within 48 hours after stent deployment. At discharge, the median NIHSS score in ten patients (including the patients with reobstruction) was 2.4. The three-month outcome was excellent (mRS, 0-1) in eight patients. In this study, BES deployment was safe and effective in patients with an immediately reoccluded MCA after successful IAT.

Authors

Lee HK, Kwak HS, Chung GH, Hwang SB

Institution

Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Korea.

Source

Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences 18:1 2012 Mar pg 80-8

MeSH

Acute Disease
Adult
Aged
Angioplasty, Balloon
Cerebral Revascularization
Combined Modality Therapy
Female
Fibrinolytic Agents
Follow-Up Studies
Humans
Infarction, Middle Cerebral Artery
Male
Middle Aged
Recurrence
Retrospective Studies
Stents
Urokinase-Type Plasminogen Activator

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22440605