| Experience of Mechanical Thrombectomy Using a Solitaire Stent |
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Sang-Soo Park , Yong-Woo Lee , Woo-Ram Shin , Hyo-Jun Kim, Dong-Gyu Shin , Tae-Sik Kong |
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Department of Neurosurgery, Seonam University College of Medicine, Presbyterian Medical Center, Jeonju, Korea |
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| Abstract |
Objective
In acute cerebral large vessel occlusion, recanalization is difficult by intravenous thrombolysis. The efficacy
of mechanical thrombectomy with a Solitaire stent has recently been reported. We evaluated the efficacy and complication
of the Solitaire stent (ev3, CA, USA) in treating acute ischemic stroke.
Methods
Fourteen patients presenting with acute ischemic stroke were retrospectively evaluated. Neurological outcomes
were assessed using the National Institutes of Health Stroke Scale (NIHSS). Recanalization was assessed
using the Thrombolysis in Cerebral Infarction(TICI) score. Inclusion criteria were as follows: (1) a NIHSS score of
≤23, (2) a TICI score of 0 to 1 in an approachable vessel, (3) no intracerebral hemorrhage or low-density lesions
on preenhanced brain CT, and (4) arrival at the hospital within 4 hours after symptom onset.
Results
14 patients were evaluated. The mean age of the patients was 70.8 years, and NIHSS scores ranged
from 3 to 23 (mean 12.57) at presentation. The mean onset time was 60 minutes (range, 15 to 120 minutes). Vessel
occlusion occurred in the middle cerebral (42.9%), internal carotid (42.9%), and basilar arteries (14.3%). After mechanical
thrombectomy with the Solitaire stent, complete perfusion occurred in 35.7% of the patients, and partial perfusion
occurred in 64.3%. On post-procedural brain CT, 8 patients had intracerebral hemorrhage. Two patients with intracerebral
hemorrhage underwent stereotactic hematoma aspiration. The number of death cases was 6. Excluding death
cases, the mean NIHSS score at 1 month was 9.5. Six patients improved in NIHSS scores. Onset time was significantly
associated with complete recanalization (p<0.05), but complete recanalization was not an indicator of good
prognosis.
Conclusion
The results of this study suggest that the Solitaire stent can show a high immediate reperfusion rate in
patients with acute cerebral large-vessel occlusion. However, successful reperfusion does not always represent good
prognosis because it can be affected by various factors. |
| Key Words:
Mechanical thrombectomyㆍIschemic strokeㆍSolitaireㆍReperfusionㆍPrognosis |
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