Acute Combined Revascularization in Acute Ischemic Stroke with Intracranial Arterial Occlusion: Self-expanding Solitaire Stent during Intravenous Thrombolysis |
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Authors: | Daniel Šaňák Martin Köcher Tomáš Veverka Marie Černá Michal Král Stanislav Buřval David Školoudík Vojtěch Prášil Jana Zapletalová Roman Herzig Petr Kaňovský |
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Affiliation: | 1. Department of Neurology, Comprehensive Stroke Center, University Hospital Olomouc, I. P. Pavlova 6, 77520 Olomouc, Czech Republic;2. Department of Radiology, Comprehensive Stroke Center, University Hospital Olomouc, I. P. Pavlova 6, 77520 Olomouc, Czech Republic;3. Department of Neurology, Palacký University Medical School, Olomouc, Czech Republic;4. Department of Medical Biophysics, Palacký University Medical School, Olomouc, Czech Republic |
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Abstract: | PurposeTo investigate the safety and efficacy of the self-expanding Solitaire stent used during intravenous thrombolysis (IVT) for intracranial arterial occlusion (IAO) in acute ischemic stroke (AIS).Materials and MethodsConsecutive nonselected patients with AIS with IAO documented on computed tomographic angiography or magnetic resonance angiography and treated with IVT were included in this prospective study. Stent intervention was initiated and performed during administration of IVT without waiting for any clinical or radiologic signs of potential recanalization. Stroke severity was assessed by National Institutes of Health Stroke Scale (NIHSS), and 90-day clinical outcome was assessed by modified Rankin scale (mRS), with a good outcome defined as an mRS score of 0–2. Recanalization was rated by thrombolysis in cerebral infarction (TICI) scale.ResultsFifty patients (mean age, 66.8 y ± 14.6) had a baseline median NIHSS score of 18.0. Overall recanalization was achieved in 94% of patients, and complete recanalization (ie, TICI 3 flow) was achieved in 72% of patients. The mean time from stroke onset to maximal recanalization was 244.2 minutes ± 87.9, with a median of 232.5 minutes. The average number of device passes was 1.5, with a mean procedure time to maximal recanalization of 49.5 minutes ± 13.0. Symptomatic intracerebral hemorrhage occurred in 6% of patients. The median mRS score at 90 days was 1, and 60% of patients had a good outcome (ie, mRS score 0–2). The overall 3-month mortality rate was 14%.ConclusionsCombined revascularization with the Solitaire stent during IVT appears to be safe and effective in the treatment of acute IAO. |
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Keywords: | AIS" },{" #name" :" keyword" ," $" :{" id" :" key0010" }," $$" :[{" #name" :" text" ," _" :" acute ischemic stroke CI" },{" #name" :" keyword" ," $" :{" id" :" key0020" }," $$" :[{" #name" :" text" ," _" :" confidence interval IAO" },{" #name" :" keyword" ," $" :{" id" :" key0030" }," $$" :[{" #name" :" text" ," _" :" intracranial arterial occlusion ICA" },{" #name" :" keyword" ," $" :{" id" :" key0040" }," $$" :[{" #name" :" text" ," _" :" internal carotid artery IMS" },{" #name" :" keyword" ," $" :{" id" :" key0050" }," $$" :[{" #name" :" text" ," _" :" Interventional Management of Stroke [trial] IVT" },{" #name" :" keyword" ," $" :{" id" :" key0060" }," $$" :[{" #name" :" text" ," _" :" intravenous thrombolysis MCA" },{" #name" :" keyword" ," $" :{" id" :" key0070" }," $$" :[{" #name" :" text" ," _" :" middle cerebral artery mRS" },{" #name" :" keyword" ," $" :{" id" :" key0080" }," $$" :[{" #name" :" text" ," _" :" modified Rankin scale NIHSS" },{" #name" :" keyword" ," $" :{" id" :" key0090" }," $$" :[{" #name" :" text" ," _" :" National Institutes of Health Stroke Scale OR" },{" #name" :" keyword" ," $" :{" id" :" key0100" }," $$" :[{" #name" :" text" ," _" :" odds ratio rt-PA" },{" #name" :" keyword" ," $" :{" id" :" key0110" }," $$" :[{" #name" :" text" ," _" :" recombinant tissue plasminogen activator TICI" },{" #name" :" keyword" ," $" :{" id" :" key0120" }," $$" :[{" #name" :" text" ," _" :" thrombolysis in cerebral infarction |
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