Clinical Outcome of Neurointerventional Emergency Treatment of Extra- or Intracranial Tandem Occlusions in Acute Major S
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O r i g i n a l A rt i c l e
Clinical Outcome of Neurointerventional Emergency Treatment of Extra- or Intracranial Tandem Occlusions in Acute Major Stroke: Antegrade Approach With Wallstent and Solitaire Stent Retriever A. Mpotsaris · M. Bussmeyer · H. Buchner · W. Weber
Received: 10 June 2012 / Accepted: 2 January 2013 / Published online: 26 January 2013 © Springer-Verlag Berlin Heidelberg 2013
Abstract Background Acute large cerebral artery occlusions respond poorly to systemic thrombolysis with recombinant tissue plasminogen activator (rTPA) alone. The value of stent retriever–based mechanical thrombectomy in patients with additional extracranial occlusion of the internal carotid artery (ICA), who require acute a priori extracranial stenting in order to reach the intracranial obstruction site, is not well known. We determined the outcome after emergency revascularization in acute stroke with tandem occlusions of the anterior circulation. Methods According to specific inclusion/exclusion criteria, eligible stroke patients with large artery occlusions underwent mechanical recanalization with the Solitaire stent retriever. In case of a tandem occlusion, we performed an acute stenting with the Wallstent before thrombectomy. From October 2009 to March 2011, 50 patients were treated according to this protocol; time frames, clinical data, recanalization rates, and midterm outcome were recorded. Results Forty-one patients had a large artery occlusion in the anterior circulation and nine in the posterior circulation. Mechanical recanalization was successful in 35/41 cases (85 %). Six of 41 patients (15 %) died in the acute phase. In 17/41 patients (42 %), thrombectomy was preceded by an emergency stenting in the extracranial portion of the internal carotid artery (ICA). National Institutes of Health A. Mpotsaris () · W. Weber Klinik für Radiologie, Neuroradiologie und interventionelle Therapie, Klinikum Vest, Knappschaftskrankenhaus, Dorstener Str. 151, 45657 Recklinghausen, Germany e-mail: [email protected] M. Bussmeyer · H. Buchner Klinik für Neurologie und Klinische Neurophysiologie, Klinikum Vest, Knappschaftskrankenhaus, Recklinghausen, Germany
Stroke Scale (NIHSS)/modified Rankin Scale (mRS) scores showed significant improvement in both the stenting group and the nonstenting group; there were no significant differences between the groups. At 90 days, 54 % of patients with emergency stenting had a good outcome. Conclusions Acute extracranial stenting with the Wallstent combined with intracranial Solitaire-based thrombectomy is safe and may lead to an improvement in neurological outcome in patients with an otherwise poor prognosis under i.v. thrombolysis alone. Keywords Acute stroke · Mechanical thrombectomy · Acute stenting · Solitaire · Stent retriever · Tandem occlusion Klinische Ergebnisse der neurointerventionellen Akutbehandlung extra-/intrakranieller TandemOkklusionen im akuten Schlaganfall: Antegrader Zugang und Behandlung mittels Wallstent und Solitaire stent-retriever Zusammenfass
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