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(Stroke. 2009;40:847.)
© 2009 American Heart Association, Inc.

Original Contributions

Stent Placement in Acute Cerebral Artery Occlusion

Use of a Self-Expandable Intracranial Stent for Acute Stroke Treatment

Caspar Brekenfeld, MD; Gerhard Schroth, MD; Heinrich P. Mattle, MD; Do-Dai Do, MD; Luca Remonda, MD; Pasquale Mordasini, MD; Marcel Arnold, MD; Krassen Nedeltchev, MD; Niklaus Meier, MD Jan Gralla, MD

From the Institute of Interventional and Diagnostic Neuroradiology (C.B., G.S., L.R., P.M., J.G.), the Clinic of Neurology (H.P.M., M.A., K.N., N.M.), and the Clinic of Angiology (D.-D.D.), University of Bern, Switzerland.

Correspondence to Gerhard Schroth, MD, PhD, University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Freiburgstrasse 4, CH-3010 Bern/Switzerland. Homepage: www.insel.ch/neurorad. E-mail gerhard.schroth{at}insel.ch

Background and Purpose— Stent placement has been applied in small case series as a rescue therapy in combination with different thrombolytic agents, percutaneous balloon angioplasty (PTA), and mechanical thromboembolectomy (MT) in acute stroke treatment. These studies report a considerable mortality and a high rate of intracranial hemorrhages when balloon-mounted stents were used. This study was performed to evaluate feasibility, efficacy, and safety of intracranial artery recanalization for acute ischemic stroke using a self-expandable stent.

Methods— All patients treated with an intracranial stent for acute cerebral artery occlusion were included. Treatment comprised intraarterial thrombolysis, thromboaspiration, MT, PTA, and stent placement. Recanalization result was assessed by follow-up angiography immediately after stent placement. Complications related to the procedure and outcome at 3 months were assessed.

Results— Twelve patients (median NIHSS 14, mean age 63 years) were treated with intracranial stents for acute ischemic stroke. Occlusions were located in the posterior vertebrobasilar circulation (n=6) and in the anterior circulation (n=6). Stent placement was feasible in all procedures and resulted in partial or complete recanalization (TIMI 2/3) in 92%. No vessel perforations, subarachnoid, or symptomatic intracerebral hemorrhages occurred. One dissection was found after thromboaspiration and PTA. Three patients (25%) had a good outcome (mRS 0 to 2), 3 (25%) a moderate outcome (mRS 3), and 6 (50%) a poor outcome (mRS 4 to 6). Mortality was 33.3%.

Conclusions— Intracranial placement of a self-expandable stent for acute ischemic stroke is feasible and seems to be safe to achieve sufficient recanalization.

Key Words: ischemic stroke • interventional neuroradiology • stent • endovascular therapy

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