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<meta name="DC.Title" content="Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions" />
<meta name="DC.Date" content="2007-05-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Stent-assisted revascularization increases prevailing recanalization rates (≅50%–69%) for vessel occlusions recalcitrant to thrombolytics. Although balloon-mounted coronary stents can displace thrombus (via angioplasty) and retain clot along vessel walls, intracranial self-expanding stents are more flexible and exert less radial outward force during deployment, increasing deliverability and safety. To understand the effectiveness of self-expanding stents for recanalization of acute cerebrovascular occlusions, we retrospectively reviewed our preliminary experience with these stents.

MATERIALS AND METHODS: Eighteen patients (19 lesions) presenting with a clinical diagnosis of acute stroke underwent catheter-based angiography documenting focal occlusion of an intracranial artery. A self-expanding stent was delivered to the occlusion and deployed. Stent placement was the initial mechanical maneuver in 6 cases; others involved a combination of pharmacologic and/or mechanical maneuvers prestenting. GP IIb/IIIa inhibitors were administered in 10 cases intraprocedurally or immediately postprocedurally to avoid acute in-stent thrombosis.

RESULTS: Stent deployment at the target occlusion (technical success) was achieved in all cases. Thrombolysis in Cerebral Ischemia (TICI)/Thrombolysis in Myocardial Ischemia (TIMI) 2/3 recanalization (angiographic success) was achieved in 15 of 19 lesions (79%). All single-vessel lesions ( n = 8) were recanalized, but only 7 of 11 combination internal carotid artery and middle cerebral artery lesions were recanalized. No intraprocedural complications occurred. Seven in-hospital deaths occurred: stroke progression, 4; intracranial hemorrhage, 2; respiratory failure, 1. Seven patients had ≥4-point National Institutes of Health Stroke Scale improvement within 24 hours after the procedure, 6 had modified Rankin Score (mRS) ≤3 at discharge, and 4 had mRS ≤3 at 3 months. Overall, revascularization and improvement in clinical outcome were more likely to occur in women.

CONCLUSION: Feasibility of self-expanding stents for treatment of acute symptomatic intracranial occlusions is shown. For single-vessel lesions, stent placement with concomitant administration of IIb/IIIa inhibitors contributed to the achievement of recanalization rates exceeding those currently reported for other means of thrombolysis." />
<meta name="DC.Contributor" content="E.I. Levy" />
<meta name="DC.Contributor" content="R. Mehta" />
<meta name="DC.Contributor" content="R. Gupta" />
<meta name="DC.Contributor" content="R.A. Hanel" />
<meta name="DC.Contributor" content="A.J. Chamczuk" />
<meta name="DC.Contributor" content="D. Fiorella" />
<meta name="DC.Contributor" content="H.H. Woo" />
<meta name="DC.Contributor" content="F.C. Albuquerque" />
<meta name="DC.Contributor" content="T.G. Jovin" />
<meta name="DC.Contributor" content="M.B. Horowitz" />
<meta name="DC.Contributor" content="L.N. Hopkins" />
<meta name="article:published_time" content="2007-05-01" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions" />
<meta name="citation_abstract" lang="en" content="&lt;p&gt;&lt;b&gt;BACKGROUND AND PURPOSE:&lt;/b&gt; Stent-assisted revascularization increases prevailing recanalization rates (≅50%–69%) for vessel occlusions recalcitrant to thrombolytics. Although balloon-mounted coronary stents can displace thrombus (via angioplasty) and retain clot along vessel walls, intracranial self-expanding stents are more flexible and exert less radial outward force during deployment, increasing deliverability and safety. To understand the effectiveness of self-expanding stents for recanalization of acute cerebrovascular occlusions, we retrospectively reviewed our preliminary experience with these stents.&lt;/p&gt;&lt;p&gt;&lt;b&gt;MATERIALS AND METHODS:&lt;/b&gt; Eighteen patients (19 lesions) presenting with a clinical diagnosis of acute stroke underwent catheter-based angiography documenting focal occlusion of an intracranial artery. A self-expanding stent was delivered to the occlusion and deployed. Stent placement was the initial mechanical maneuver in 6 cases; others involved a combination of pharmacologic and/or mechanical maneuvers prestenting. GP IIb/IIIa inhibitors were administered in 10 cases intraprocedurally or immediately postprocedurally to avoid acute in-stent thrombosis.&lt;/p&gt;&lt;p&gt;&lt;b&gt;RESULTS:&lt;/b&gt; Stent deployment at the target occlusion (technical success) was achieved in all cases. Thrombolysis in Cerebral Ischemia (TICI)/Thrombolysis in Myocardial Ischemia (TIMI) 2/3 recanalization (angiographic success) was achieved in 15 of 19 lesions (79%). All single-vessel lesions (&lt;i&gt;n&lt;/i&gt; = 8) were recanalized, but only 7 of 11 combination internal carotid artery and middle cerebral artery lesions were recanalized. No intraprocedural complications occurred. Seven in-hospital deaths occurred: stroke progression, 4; intracranial hemorrhage, 2; respiratory failure, 1. Seven patients had ≥4-point National Institutes of Health Stroke Scale improvement within 24 hours after the procedure, 6 had modified Rankin Score (mRS) ≤3 at discharge, and 4 had mRS ≤3 at 3 months. Overall, revascularization and improvement in clinical outcome were more likely to occur in women.&lt;/p&gt;&lt;p&gt;&lt;b&gt;CONCLUSION:&lt;/b&gt; Feasibility of self-expanding stents for treatment of acute symptomatic intracranial occlusions is shown. For single-vessel lesions, stent placement with concomitant administration of IIb/IIIa inhibitors contributed to the achievement of recanalization rates exceeding those currently reported for other means of thrombolysis.&lt;/p&gt;" />
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<meta name="twitter:title" content="Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Stent-assisted revascularization increases prevailing recanalization rates (≅50%–69%) for vessel occlusions recalcitrant to thrombolytics. Although balloon-mounted coronary stents can displace thrombus (via angioplasty) and retain clot along vessel walls, intracranial self-expanding stents are more flexible and exert less radial outward force during deployment, increasing deliverability and safety. To understand the effectiveness of self-expanding stents for recanalization of acute cerebrovascular occlusions, we retrospectively reviewed our preliminary experience with these stents.

MATERIALS AND METHODS: Eighteen patients (19 lesions) presenting with a clinical diagnosis of acute stroke underwent catheter-based angiography documenting focal occlusion of an intracranial artery. A self-expanding stent was delivered to the occlusion and deployed. Stent placement was the initial mechanical maneuver in 6 cases; others involved a combination of pharmacologic and/or mechanical maneuvers prestenting. GP IIb/IIIa inhibitors were administered in 10 cases intraprocedurally or immediately postprocedurally to avoid acute in-stent thrombosis.

RESULTS: Stent deployment at the target occlusion (technical success) was achieved in all cases. Thrombolysis in Cerebral Ischemia (TICI)/Thrombolysis in Myocardial Ischemia (TIMI) 2/3 recanalization (angiographic success) was achieved in 15 of 19 lesions (79%). All single-vessel lesions ( n = 8) were recanalized, but only 7 of 11 combination internal carotid artery and middle cerebral artery lesions were recanalized. No intraprocedural complications occurred. Seven in-hospital deaths occurred: stroke progression, 4; intracranial hemorrhage, 2; respiratory failure, 1. Seven patients had ≥4-point National Institutes of Health Stroke Scale improvement within 24 hours after the procedure, 6 had modified Rankin Score (mRS) ≤3 at discharge, and 4 had mRS ≤3 at 3 months. Overall, revascularization and improvement in clinical outcome were more likely to occur in women.

CONCLUSION: Feasibility of self-expanding stents for treatment of acute symptomatic intracranial occlusions is shown. For single-vessel lesions, stent placement with concomitant administration of IIb/IIIa inhibitors contributed to the achievement of recanalization rates exceeding those currently reported for other means of thrombolysis." />
<meta name="og-title" property="og:title" content="Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/28/5/816" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Stent-assisted revascularization increases prevailing recanalization rates (≅50%–69%) for vessel occlusions recalcitrant to thrombolytics. Although balloon-mounted coronary stents can displace thrombus (via angioplasty) and retain clot along vessel walls, intracranial self-expanding stents are more flexible and exert less radial outward force during deployment, increasing deliverability and safety. To understand the effectiveness of self-expanding stents for recanalization of acute cerebrovascular occlusions, we retrospectively reviewed our preliminary experience with these stents.

MATERIALS AND METHODS: Eighteen patients (19 lesions) presenting with a clinical diagnosis of acute stroke underwent catheter-based angiography documenting focal occlusion of an intracranial artery. A self-expanding stent was delivered to the occlusion and deployed. Stent placement was the initial mechanical maneuver in 6 cases; others involved a combination of pharmacologic and/or mechanical maneuvers prestenting. GP IIb/IIIa inhibitors were administered in 10 cases intraprocedurally or immediately postprocedurally to avoid acute in-stent thrombosis.

RESULTS: Stent deployment at the target occlusion (technical success) was achieved in all cases. Thrombolysis in Cerebral Ischemia (TICI)/Thrombolysis in Myocardial Ischemia (TIMI) 2/3 recanalization (angiographic success) was achieved in 15 of 19 lesions (79%). All single-vessel lesions ( n = 8) were recanalized, but only 7 of 11 combination internal carotid artery and middle cerebral artery lesions were recanalized. No intraprocedural complications occurred. Seven in-hospital deaths occurred: stroke progression, 4; intracranial hemorrhage, 2; respiratory failure, 1. Seven patients had ≥4-point National Institutes of Health Stroke Scale improvement within 24 hours after the procedure, 6 had modified Rankin Score (mRS) ≤3 at discharge, and 4 had mRS ≤3 at 3 months. Overall, revascularization and improvement in clinical outcome were more likely to occur in women.

CONCLUSION: Feasibility of self-expanding stents for treatment of acute symptomatic intracranial occlusions is shown. For single-vessel lesions, stent placement with concomitant administration of IIb/IIIa inhibitors contributed to the achievement of recanalization rates exceeding those currently reported for other means of thrombolysis." />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node6958--5" data-node-nid="6958" id="top-node-6958--6977100772" data-pisa="ajnr;28/5/816" data-pisa-master="ajnr;28/5/816" data-apath="/ajnr/28/5/816.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">INTERVENTIONAL</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">E.I. Levy</span>, <span class="highwire-citation-author" data-delta="1">R. Mehta</span>, <span class="highwire-citation-author" data-delta="2">R. Gupta</span>, <span class="highwire-citation-author" data-delta="3">R.A. Hanel</span>, <span class="highwire-citation-author" data-delta="4">A.J. Chamczuk</span>, <span class="highwire-citation-author" data-delta="5">D. Fiorella</span>, <span class="highwire-citation-author" data-delta="6">H.H. Woo</span>, <span class="highwire-citation-author" data-delta="7">F.C. Albuquerque</span>, <span class="highwire-citation-author" data-delta="8">T.G. Jovin</span>, <span class="highwire-citation-author" data-delta="9">M.B. Horowitz</span> and <span class="highwire-citation-author" data-delta="10">L.N. Hopkins</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2007,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">28 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">816-822; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-6958--6977100772" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">E.I. Levy </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.I.%2BLevy%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Levy%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AE.I.%2BLevy%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">R. 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    <div class="messages highwire-corrections highwire-correction-type-correction"><h3 class="highwire-corrections-title">This article has a correction. Please see:</h3><ul class="highwire-corrections-list"><li class="relation-216 first last"><a href="/content/28/8/1624.2" class="" data-icon-position="" data-hide-link-title="0">Erratum - September 01, 2007</a></li></ul></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 28</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 5 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">May 2007 </div></div>
      
      
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      <div class="highwire-cite-title">Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">E.I.</span> <span class="nlm-surname">Levy</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Mehta</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Gupta</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">R.A.</span> <span class="nlm-surname">Hanel</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.J.</span> <span class="nlm-surname">Chamczuk</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Fiorella</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">H.H.</span> <span class="nlm-surname">Woo</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">F.C.</span> <span class="nlm-surname">Albuquerque</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">T.G.</span> <span class="nlm-surname">Jovin</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">M.B.</span> <span class="nlm-surname">Horowitz</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">L.N.</span> <span class="nlm-surname">Hopkins</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2007, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">28 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">816-822; </span></div>
  
  
  
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      <div class="highwire-cite-title">Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">E.I.</span> <span class="nlm-surname">Levy</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Mehta</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Gupta</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">R.A.</span> <span class="nlm-surname">Hanel</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.J.</span> <span class="nlm-surname">Chamczuk</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">D.</span> <span class="nlm-surname">Fiorella</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">H.H.</span> <span class="nlm-surname">Woo</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">F.C.</span> <span class="nlm-surname">Albuquerque</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">T.G.</span> <span class="nlm-surname">Jovin</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">M.B.</span> <span class="nlm-surname">Horowitz</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">L.N.</span> <span class="nlm-surname">Hopkins</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2007, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">28 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">816-822; </span></div>
  
  
  
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