Abstract
Background and Purpose:
Major cerebral thromboembolism often resists recanalization with currently available techniques. The authors present their initial experience with a self-expanding stent for use in intracranial vascular reconstruction, permitting immediate recanalization of acute thromboembolic occlusions of the anterior circulation.
Patients and Methods:
Patients treated with the Cordis Enterprise™ self-expanding intracranial stent system for acute thromboembolic occlusion of the major anterior cerebral arteries were included. Treatment comprised systemic and intraarterial thrombolysis, mechanical thrombectomy, and stent placement. Stent deployment, recanalization rate by means of Thrombolysis In Cerebral Infarction (TICI) scores and the clinical outcome were all assessed.
Results:
Six patients presenting with acute carotid T (n = 2) or proximal middle cerebral artery occlusion (n = 4) were treated. The mean National Institutes of Health Stroke Scale (NIHSS) score at presentation was 14; the mean age was 57 years. Successful stent deployment and immediate recanalization were achieved in all six with a TICI score of ≥ 2. Neither distal emboli nor any procedure-related complications were encountered. One patient developed symptomatic intracerebral hemorrhage and two patients needed decompressive craniectomy after treatment. The mean NIHSS score at 10 days was 10, but only one patient showed a complete recovery at 3 months.
Conclusion:
Intracranial placement of the Enterprise™ self-expanding stent has proven to be feasible and efficient in achieving immediate recanalization of occluded main cerebral arteries. The use of antiplatelet therapy after treatment may, however, increase the risk of reperfusion intracerebral hemorrhage.
Zusammenfassung
Hintergrund und Ziel:
Die Wiedereröffnung großer thromboembolisch verschlossener Arterien gelingt mit bisherigen endovaskulären Techniken häufig nicht. Die Autoren berichten über ihre Erfahrungen mit einem selbstexpandierenden Stentsystem zur Wiederherstellung des Blutflusses bei Patienten mit akutem thrombembolischem Verschluss in der vorderen Hirnzirkulation.
Patienten und Methodik:
Patienten mit Verschluss einer großen Arterie in der vorderen Gerhirnkreislauf, die mit einem Enterprise-Stentsystem (Cordis Enterprise™) behandelt wurden, wurde in diese Studie eingeschlossen. Die Behandlung beinhaltete darüber hinaus eine systemische und intraarterielle Lyse sowie eine mechanische Thrombektomie. Die Stent applikation, die Rekanalisierung unter Verwendung der TICI-Scores (Thrombolysis In Cerebral Infarctions) Scores und der klinische Verlauf wurden analysiert und bewertet.
Ergebnisse:
Sechs Patienten wurden eingeschlossen. Zwei Patienten hatten einen Karotis-T-Verschluss und vier Patienten einen Verschluss der A. cerebri media. Der durchschnittliche NIHSS-Score (National Institutes of Health Stroke Scale) Scores betrug bei Aufnahme 14; das mittlere Alter lag bei 57 Jahren. Die Stentapplikation war bei allen Patienten erfolgreich, und eine Rekanalisierung mit einem TICI-Score ≥ 2 konnte in allen Fällen erzielt werden. Distale Emboli und prozedurale Komplikationen traten nicht auf. Im Verlauf erlitt ein Patient eine symptomatische intrazerebrale Blutung, zwei weitere Patienten mussten zur Druckentlastung kraniektomiert werden. Der mittlere NIHSS-Score nach 10 Tagen betrug 10; nur ein Patient zeigte eine komplette Restitution nach 3 Monaten.
Schlussfolgerung:
Die intrakranielle Applikation des Enterprise-Stentsystems (Cordis Enterprise™) zur Behandlung großer arterieller Verschlüsse im vorderen Gehirnkreislauf ist möglich und sicher durchführbar. In dieser Serie zeigt sich eine hohe Effizienz mit Reperfusion bei allen Patienten. Die Gabe von Thrombozytenfunktionshemmern erhöht möglicherweise das Risiko einer großen Reperfusionsblutung.
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Kulcsár, Z., Bonvin, C., Lovblad, KO. et al. Use of the Enterprise™ Intracranial Stent for Revascularization of Large Vessel Occlusions in Acute Stroke. Clin Neuroradiol 20, 54–60 (2010). https://doi.org/10.1007/s00062-010-9024-x
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DOI: https://doi.org/10.1007/s00062-010-9024-x