Background
The feasibility and efficacy of intracranial stenting were evaluated for patients
with a stroke-in-evolution after the time window for thrombolysis.
Methods
Patients with symptomatic intracranial steno-occlusive disease with progressive or
fluctuating symptoms were treated using intracranial stenting after the time window
for hyperacute thrombolysis.
Results
Within the study period, we identified 10 patients (7 men, 62.5 ± 11.3 years old)
who were eligible for inclusion. The median onset-to-arrival time was 5.8 hours (range:
.6-144 hours), and the median onset-to-procedure time was 33 hours (range: 8-346 hours).
Only 1 patient previously received intravenous thrombolysis using alteplase. The symptomatic
occlusive artery was the right middle cerebral artery, left middle cerebral artery,
and basilar artery in 3, 1, and 6 patients, respectively. The median initial National
Institutes of Health Stroke Scale (NIHSS) score was 4 (range: 0-6), and the median
NIHSS score measured immediately before the procedure was 8 (range: 4-26). All but
1 patient underwent successful angioplasty and stenting using a Wingspan stent. Reocclusion
of the stented artery occurred in 1 patient, and his neurological status deteriorated
to coma. A favorable outcome (modified Rankin Scale ≤2) at 3 months was noted in 7
patients (70%).
Conclusion
Intracranial stenting could be considered an alternative strategy for treating patients
with medically intractable stroke-in-evolution.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013; 44: 2064-2089
- Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment.Lancet Neurol. 2013; 12: 1106-1114
- Natural history of intracranial atherosclerotic disease.Front Neurol. 2014; 5: 125
- Predictors of neurological deterioration during hospitalization: results from the Chinese Intracranial Atherosclerosis (CICAS) Study.Neurol Res. 2015; 37: 385-390
- Endovascular mechanical thrombectomy for acute ischemic stroke: a new standard of care.J Stroke. 2015; 17: 123-126
- Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 2160-2236
- Stenting versus aggressive medical therapy for intracranial arterial stenosis.N Engl J Med. 2011; 365: 993-1003
- Progression of stroke after arrival at hospital.Stroke. 1985; 16: 629-632
- Stroke-in-evolution: infarct-inherent mechanisms versus systemic causes.Cerebrovasc Dis. 2006; 21: 42-46
- Deteriorating stroke: diagnostic criteria, predictors, mechanisms and treatment.Cerebrovasc Dis. 1999; 9: 1-8
- Thrombolysis in patients with marked clinical fluctuations in neurologic status due to cerebral ischemia.Arch Neurol. 2008; 65: 1041-1043
- C-reactive protein is a predictor of early neurologic deterioration in acute ischemic stroke.J Stroke Cerebrovasc Dis. 2012; 21: 181-186
- Steno-occlusive arterial disease and early neurological deterioration in acute ischemic stroke.Cerebrovasc Dis. 2008; 25: 151-156
- MRI findings may predict early neurologic deterioration in acute minor stroke or transient ischemic attack due to intracranial atherosclerosis.Eur Neurol. 2010; 64: 95-100
- Internal and cortical border-zone infarction: clinical and diffusion-weighted imaging features.Stroke. 2006; 37: 841-846
- Mechanisms of acute cerebral infarctions in patients with middle cerebral artery stenosis: a diffusion-weighted imaging and microemboli monitoring study.Ann Neurol. 2002; 52: 74-81
- Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis.N Engl J Med. 2005; 352: 1305-1316
- Partial aortic occlusion for cerebral perfusion augmentation: safety and efficacy of NeuroFlo in Acute Ischemic Stroke trial.Stroke. 2011; 42: 1680-1690
- High-dose albumin treatment for acute ischaemic stroke (ALIAS) Part 2: a randomised, double-blind, phase 3, placebo-controlled trial.Lancet Neurol. 2013; 12: 1049-1058
- Effect of a balloon-expandable intracranial stent vs medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: the VISSIT randomized clinical trial.JAMA. 2015; 313: 1240-1248
- First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (stent-assisted recanalization in acute ischemic stroke).Stroke. 2009; 40: 3552-3556
Article info
Publication history
Published online: March 22, 2016
Accepted:
January 31,
2016
Received in revised form:
January 10,
2016
Received:
October 28,
2015
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.01.054
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
