Clinical efficacy of tirofiban combined with a Solitaire stent in treating acute ischemic stroke

This study explores the safety and effect of acute cerebral infarction treatment by microcatheter injection of tirofiban combined with a Solitaire AB stent and/or stent implantation. Emergency cerebral angiograms showing the responsible vascular occlusion of 120 acute cerebral infarction patients who underwent emergency endovascular thrombectomy were included in the study. These patients were randomly divided into two groups using the random number table method: treatment group (n=60) that received thrombectomy (with cerebral artery stents) combined with intracerebral injection of tirofiban and control group (n=60) that only received thrombectomy (with cerebral artery stents alone). The baseline data, cerebral angiography before and after surgery, hospitalization, and follow-up results of patients in these two groups were compared. Furthermore, the incidence of major adverse cerebrovascular events of these two groups was compared (90-day modified Rankin scale, a score of 0-2 indicates a good prognosis). The difference between baseline clinical data and brain angiography between these two groups was not statistically significant. Patients in the treatment group had a higher prevalence of thrombolysis in cerebral infarction grade 2b/3 than patients in the control group (88.3% (53/60) vs 66.7% (40/60), P=0.036). Moreover, the National Institutes of Health Stroke Scale scores 7 days after surgery and the 90-day prognosis were all better for the patients who received tirofiban (P=0.048 and P=0.024). Mechanical thrombectomy with Solitaire AB stents in combination with the injection of tirofiban through a microcatheter appears to be safe and effective for the endovascular treatment of acute ischemic stroke.

The application of indwelling guide-wire technique in performing mechanical thrombectomy for acute cerebral artery occlusion / 介入放射学杂志

Objective To discuss the application value,safety and feasibility of indwelling guidewire technique in performing mechanical thrombectomy for acute cerebral artery occlusion.Methods The clinical data of 15 patients with acute ischemic stroke,who were treated with mechanical thromnectomy at authors' hospital during the period from December 2015 to February 2016,were retrospectively analyzed.The diseases included middle cerebral artery occlusion (n=6),internal carotid artery and middle cerebral artery occlusion (n=5) and vertebral basilar artery occlusion (n=4).Indwelling guide-wire technique was adopted to quickly and accurately determine the vascular occlusion characteristics,then,endovascular mechanical thrombectomy was carried out.Results By using indwelling guide-wire technique,the occlusive features of the diseased arteries were successfully and precisely determined.Immediate recanalization of the occluded artery was obtained in 13 patients (87％).The blood flow classification score after thrombolysis in cerebral infarction (TICI) reached 3 points in 10 patients and 2b points in 5 patients.In 2 patients,the vascular recanalization procedure failed because the thrombus load was large,the length of occluded segment was long,and the effect of mechanical thromnectomy was poor.According to American National Institutes of Health Stroke Scale (NIHSS),the evaluation score was improved from preoperative (19.2±7.0) to postoperative (6.3±3.6),the difference was statistically significant (P＜0.05).Three months after the treatment,the score measured by modified Rankin scale(mRS) was ≤2 points in 10 patients.Conclusion Mechanical thrombectomy is safe and effective for the treatment of acute cerebral artery occlusion.The indwelling guide-wire technique can safely,conveniently,quickly and accurately determine the characteristics of the occluded blood vessels,which is very helpful in assisting surgical manipulation,reducing procedure-related complications,and improving vascular recanalization rate.(J Intervent Radiol,2017,26:202-205)

Effect of mechanical thrombectomy with Solitaire stent in the treatment of acute intracranial large artery occlusion / 中国综合临床

Objective To evaluate the safety and effectiveness of mechanical thrombectomy with Solitaire AB stent in the treatment of large intracranial artery occlusions.Methods The calinical data of 15 patients with acute stroke(more than 3.5 h intravenous thrombolysis time window) who were carried out arterial embolectomy with Solitaire AB stent in the No.264th Hospital of the Chinese People's Liberation Army were retrospective analyzed.There were 11 cases of middle cerebral artery(MCA),2 cases of internal carotid artery (ICA),1 case of vertebral artery(VA) pluse basilar artery(BA),and 1 case of anterior artery(AA).The recanalization occluded situation and surgical complications were analyzed,NIHSS score of preoperatively and at discharge were compared.Results In 15 cases,there were 14 cases of totally recanalization,1 case of partial recanalization.Two case with MCA stenosis and 1 case with VA stenosis after the recanalization were accepted stent angioplasty,2 csase died.NIHSS score of 13 cases survival patients increased from (22.85±4.75) scores on admission to (4.39 ±3.67) scores out of hospital,and the difference was statistically sinificant(t=2.752,P ＜0.01).Conclusion The mechanical thrombectomy with Solitaire AB stent can get high recanalization rate,fewer complications and good clinical outcome on patients with large intracranial artery occlusions.For more than venous or arterial thrombolysis time window,the mechanical thrombectomy can be considered within the 8 h after comprehensive evaluation.

Efficacy comparison of Solitaire AB and Enterprise stent-assisted embolization of intracranial wide-necked aneurysms / 中国脑血管病杂志

Objective To compare the effect of Solitaire AB and Enterprise stent-assisted endovascular embolization of intracranial wide-necked aneurysms. Methods The clinical data 218 patients with intracranial aneurysm treated with Solitaire AB stent or Enterprise stent in Guangdong General Hospital from January 2012 to December 2014 were analyzed retrospectively. Seventy patients were treated with Solitaire AB stents and 148 were treated with Enterprise stents. They were followed up after procedure (2 months to 2 years). The Raymond grade and the modified Rankin scale (mRS)scores were used to compare the efficacy of the 2 kinds of stents. Results There were no significant differences in patients before procedure in the Hunt-Hess grade (Z = 1. 550,P = 0. 121),Fisher grade (Z =1. 537,P =0. 124),aneurysm size (Z =0. 192,P =0. 848),and position (χ2 = 0. 337,P = 0. 736)between the 2 stent groups,while there were no significant differences in patients after procedure in the instant Raymond grade (Z = 0. 682,P = 0. 495), follow-up Raymond grade (Z = 0. 206,P =0. 837),and mRS score (P =0. 662)between the 2 stent groups. Further multivariate Logistic regression analysis showed that the stent type (Solitaire AB stent or Enterprise stent),Raymond grade follow-up grade (OR,0. 029 ,95% CI 0. 126 - 0. 199,P = 0. 661 ),and postoperative mRS score (OR,2. 000,95% CI 0. 204 - 19. 603,P = 0. 552)had no influence on the prognosis. Conclusions In the assisted embolization of intracranial wide-necked aneurysms using the Solitaire AB and Enterprise stents,the effects of both stents are good in the assisted embolization of intracranial wide-necked aneurysms.

Analysis of curative effect of arterial embolectomy with Solitaire AB stent in treatment of acute intracranial large artery occlusion / 中国医师进修杂志

Objective To explore the efficacy and safety of arterial embolectomy with Solitaire AB stent in treatment of acute intracranial large artery occlusion.Methods The clinical data of 11 patients with acute intracranial large artery occlusion receiving arterial embolectomy with Solitaire AB stent from March to December 2013 were analyzed retrospectively.Among them,5 cases were with simple middle cerebral artery occlusion,1 case combined with occlusion in the intracranial part of the internal carotid artery,4 cases had simple basilar artery occlusion,and 1 case had occlusion in the intracranial portion of the vertebral arteries extending to intracranial portion of the basilar artery.Revascularization and postoperative hemorrhage were analyzed,and nosocomial as well as clinical outcomes after 3 months were evaluated.Results Ten patients showed successful revascularization,of which 8 cases reached the standard of perfect revascularization.After embolectomy,there was obvious stenosis in offending vessel of 4 cases,who were given balloon dilatation then.In 3 cases,the vessels were still narrow,so Solitaire AB stent was placed in the stenosis area to correct stenosis with the residual stenosis rate of less than 40％.Thus electrolytic interruption was given.There was no symptomatic intracranial hemorrhage.Three months after the operation,5 cases recovered,among whom 2 cases had obvious curative effect instantly,1 case had complete remissions in 1 week,and 1 case remained hemiplegia.Five cases died,and 4 cases discharged from the hospital because their family gave up the subsequent treatment.Conclusions Arterial embolectomy with Solitaire AB stent to treat patients with acute intracranial large artery occlusion has a relatively higher revascularization rate.The clinical outcome after 3 months can be significantly improved.Thus,it provides a safe and effective endovascular treatment for patients with acute intracranial large artery occlusion.

Perioperative nursing of acute intracranial arterial occlusion treated with mechanical thrombectomy with Solitaire AB stent / 现代临床护理

Objective To summarize the perioperative nursing of acute intracranial arterial occlusion treated with mechanical thrombectomy with Solitaire AB stent.Methods Fifty-three cases of acute intracranial arterial occlusion were treated with mechanical thrombectomy with Solitaire AB stent.Before the operation,emergency green passage was established and after the operation,the nursing measures included close observation of conditions,intensified basic nursing,control and management of blood pressure and medication,prevention from the complications by reperfusion injury and early rehabilitative training.Results The mechanical thrombectomy with Solitaire AB stent was successful for all the 53 patients.The occlusions in the blood vessels of 44 cases were fully removed and those in 9 cases were partially removed,3 treated with stent for stenosis.Conclusion The nursing points for acute intracranial arterial occlusion treated with mechanical thrombectomy with Solitaire AB stent include preoperative effective preparation, close observation of the disease conditions such as changes in their consciousness and blood pressure,prevention from reperfusion injury and early rehabilitative training.

Mechanical Thrombectomy Using a Solitaire Stent in Acute Ischemic Stroke; Initial Experience in 40 Patients

OBJECTIVE: This study was conducted in order to demonstrate the initial experience of the Solitaire AB stent in mechanical intracranial thrombectomy. METHODS: We conducted a retrospective review of 40 consecutive patients who underwent intra-arterial Solitaire AB stent thrombectomy for treatment of acute ischemic strokes between October 2010 and November 2011. Demographic, clinical, and radiological presentations and outcomes were studied. RESULTS: Twenty six men and 14 women with a mean initial National Institutes of Health Stroke Scale (NIHSS) score of 14.1 (range, 8-26) and a mean age of 65.4 (range, 32-89) years were included in this study. Occlusion sites were as follows: internal carotid artery (n = 11), middle cerebral artery M1 (n = 22), M2 (n = 5), and basilar artery (n = 2). Successful revascularization was achieved in 36 (90%) patients. The mean NIHSS score was 11.6 (range, 1-23) at 24 hours after the procedure, and 42.5% of patients showed a modified Rankin scale score of < or = 2 at 90 days. New occlusion by migrated emboli was observed in one (2.5%) case. Post-procedural intracerebral hemorrhage occurred in only one case (2.5%), with an all-cause mortality of two (5%). CONCLUSION: The Solitaire AB device is a relatively safe and effective tool for use in performance of mechanical thrombectomy in patients with acute ischemic stroke.

Waffle-Cone Technique Using Solitaire AB Stent

The waffle-cone technique is a modified stent application technique, which involves protrusion of the distal portion of a stent into an aneurysm fundus to provide neck support for subsequent coiling. The authors report two cases of wide necked basilar bifurcation aneurysms, which were not amenable to stent assisted coiling, that were treated using the waffle-cone technique with a Solitaire AB stent. A 58-year-old woman presented with severe headache. Brain CT showed subarachnoid hemorrhage and angiography demonstrated a ruptured giant basilar bifurcation aneurysm with broad neck, which was treated with a Solitaire AB stent and coils using the waffle-cone technique. The second case involved an 81-year-old man, who presented with dizziness caused by brain stem infarction. Angiography also demonstrated a large basilar bifurcation unruptured aneurysm with broad neck. Solitaire AB stent deployment using the waffle-cone technique, followed by coiling resulted in near complete obliteration of aneurysm. The waffle-cone technique with a Solitaire AB stent can be a useful alternative to conventional stent application when it is difficult to catheterize bilateral posterior cerebral arteries in patients with a wide-necked basilar bifurcation aneurysm.

Waffle-Cone Technique Using Solitaire AB Stent

The waffle-cone technique is a modified stent application technique, which involves protrusion of the distal portion of a stent into an aneurysm fundus to provide neck support for subsequent coiling. The authors report two cases of wide necked basilar bifurcation aneurysms, which were not amenable to stent assisted coiling, that were treated using the waffle-cone technique with a Solitaire AB stent. A 58-year-old woman presented with severe headache. Brain CT showed subarachnoid hemorrhage and angiography demonstrated a ruptured giant basilar bifurcation aneurysm with broad neck, which was treated with a Solitaire AB stent and coils using the waffle-cone technique. The second case involved an 81-year-old man, who presented with dizziness caused by brain stem infarction. Angiography also demonstrated a large basilar bifurcation unruptured aneurysm with broad neck. Solitaire AB stent deployment using the waffle-cone technique, followed by coiling resulted in near complete obliteration of aneurysm. The waffle-cone technique with a Solitaire AB stent can be a useful alternative to conventional stent application when it is difficult to catheterize bilateral posterior cerebral arteries in patients with a wide-necked basilar bifurcation aneurysm.