A Comparison of Stent-Assisted Mechanical Thrombectomy and Conventional Intra-Arterial Thrombolysis for Acute Cerebral Infarction

Abstract

Background and PurposeWe evaluated whether stent-assisted thrombectomy (SAT) is safer or more clinically beneficial than aggressive mechanical clot disruption (AMCD) for patients with acute intracranial artery occlusion.MethodsWe retrospectively analyzed the clinical data of 72 patients (33 with SAT and 39 with AMCD) who underwent intra-arterial thrombolysis for acute intracranial artery occlusions. Procedure parameters, clinical outcomes, and incidence of complications were compared between the SAT and AMCD groups.ResultsThe time interval to recanalization was shorter in SAT patients (69.2±39.6 minutes, mean±standard deviation) than in AMCD patients (94.4±48.0 minutes, p<0.05). Recanalization was achieved in more SAT patients (91%) than AMCD patients (80%), but with no statistically significance. Urokinase was used less frequently in SAT patients (21%) than in AMCD patients (92%, p<0.05), and the incidence of symptomatic hemorrhages was lower in SAT patients (3%) than in AMCD patients (18%, p<0.05). Device-related complications in SAT patients comprised two cases of stent fracture and one case of distal migration of a captured thrombus. The proportion of patients with good outcomes, defined as scores from 0 to 3 on the modified Rankin Scale, was similar in the two groups at discharge (SAT, 46%; AMCD, 39%), but significantly higher in the SAT group than in the AMCD group at 3 months (64% vs. 40%, p<0.05) and 6 months (67% vs. 42%, p<0.05) after discharge.ConclusionsThe outcomes and clinical parameters were better for SAT during thrombolytic procedures for acute intracranial artery occlusions than for AMCD for up to 6 months. However, some device-related complications occurred during stent interventions.

RETRACTED: Tanshinone inhibits neuronal cell apoptosis and inflammatory response in cerebral infarction rat model

“…Cerebral infarction is a severe cardiovascular and cerebrovascular disease, which often occurs due to brain hypoxic-ischemic necrosis, resulting in embolism and thrombosis. 1 Although thrombectomy 2 and drug therapy 3 have been widely applied to clinical therapy of cerebral infarction, the therapeutic effect is still limited. It has been well known that accelerated neuronal cell apoptosis and inflammatory response have been proved to be associated with the cerebral infarction.…”

Impacts of Rapid Recanalization and Collateral Circulation on Clinical Outcome after Intraarterial Thrombolysis

“…IAT was performed as either bridging therapy after IVT or primary therapy as per the critical pathway established at the Regional Cerebrovascular Center of Chungnam National University Hospital. 12 Patients who arrived at the ER within 3 hours of symptom onset with no hemorrhage or significant low density on initial computed tomography (i.e., less than one-third of the MCA territory) were administered 0.9 mg/kg recombinant tissue plasminogen activator (tPA). If the patient exhibited no clinical improvement after IVT and there were image mismatches between diffusion- and perfusion-weighted images on magnetic resonance imaging (MRI), IAT was performed as bridging therapy.…”

“…13 From November 2010 to February 2013, we used stent-assisted thrombectomy with a retrievable stent (Solitaire AB, ev3, Covidien, Dublin, Ireland). 12 If the recanalized artery became re-occluded after stent-assisted thrombectomy, balloon angioplasty and/or stenting were performed.…”

Evaluation of VEGFA gene variants for possible roles in cerebral infarction diseases

“…In other side, this disease also leading to other diseases, such as sensory disability, language barrier, repeated paralysis, dementia [7,10,11] . Although a variety of therapies or methods have been applied to treat the disease in clinical [12,13] , but few are effective [14,15] .…”