Critical Use of Balloon Angioplasty after Recanalization Failure with Retrievable Stent in Acute Cerebral Artery Occlusion

Abstract

ObjectiveSudden major cerebral artery occlusion often resists recanalization with currently available techniques or can results in massive symptomatic intracranial hemorrhage (sICH) after thrombolytic therapy. The purpose of this study was to examine mechanical recanalization with a retrievable self-expanding stent and balloon in acute intracranial artery occlusions.MethodsTwenty-eight consecutive patients with acute intracranial artery occlusions were treated with a Solitaire retrievable stent. Balloon angioplasty was added if successful recanalization was not achieved after stent retrieval. The angiographic outcome was assessed by Thrombolysis in Cerebral Infarction (TICI) and the clinical outcomes were assessed by the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS).ResultsAt baseline, mean age was 69.4 years and mean initial NIHSS score was 12.5. A recanalization to TICI 2 or 3 was achieved in 24 patients (85%) after stent retrieval. Successful recanalization was achieved after additional balloon angioplasty in 4 patients. At 90-day follow-up, 24 patients (85%) had a NIHSS improvement of ≥4 and 17 patients (60%) had a good outcome (mRS ≤2). Although there was sICH, there was one death associated with the procedure.ConclusionMechanical thromboembolectomy with a retrievable stent followed by additional balloon angioplasty is a safe and effective first-line therapy for acute intracranial artery occlusions especially in case of unsuccessful recanalization after stent thrombectomy.

Adjuvant Tirofiban Injection Through Deployed Solitaire Stent As a Rescue Technique After failed Mechanical Thrombectomy in Acute Stroke

“…Despite higher recanalization rates of 61-85% [1, 2, 4, 8], not a few patients are still left without sufficient recanalization after mechanical thromectomy using Solitaire stent. Several different techniques to treat refractory cases to mechanical thrombectomy using stent retriever have been previously introduced.…”

“…However, failure of mechanical thrombectomy to achieve successful revascularization has been reported in 20-30% of treated cases. In cases resistant to mechanical thrombectomy, several techniques have been introduced as a rescue method including the use of other stent retrievers, intraarterial thrombolysis, stent implantation [ 3 ], balloon angioplasty [ 4 ] and double Solitaire mechanical thrombectomy [ 5 ]. Here, we present our experiences of another rescue technique in which adjunctive tirofiban was injected through temporarily deployed Solitaire stent after failure of initial mechanical thrombectomy.…”

Combined Use of Mechanical Thrombectomy with Angioplasty and Stenting for Acute Basilar Occlusions with Underlying Severe Intracranial Vertebrobasilar Stenosis: Preliminary Experience from a Single Chinese Center

“…4 For the treatment of BAO, mechanical thrombectomy with stent retrievers has emerged in recent years as a promising method with a higher recanalization rate and better functional outcome. 5,6 However, for those with underlying severe stenosis, there have been concerns over the feasibility and safety of these devices: Reperfusion may fail to be achieved by mechanical thrombectomy devices alone in patients with severe stenosis 7 ; retrieval of the stent retrievers past the stenosis may damage the endothelium or the atherosclerotic plaque, leading to an increased risk of acute thrombosis and reocclusion; and the resistance posed by the stenosis may cause distortion of the natural course of the vessel during the tug of the retrievers past the stenosis, leading to tearing of the perforator vessels and intracerebral hemorrhage. We hereby report our experience with 13 patients treated with a combination of mechanical thrombectomy with the Solitaire device (Covidien, Irvine, California) for the thrombosis and angioplasty with stent placement for the underlying stenosis.…”

Solitaire stent in the treatment of acute ischemic stroke with large cerebral artery occlusion

“…The patient 1 in postoperative patients with middle cerebral artery stenosis, M1 segment on the research report further used the balloon dilatation, and obtained the good blood flow and clinical prognosis [ 19 ]. Although mechanical bolt can significantly improve the rate of recanalization, it also has the risk of symptomatic intracranial hemorrhage.…”