Safety of intravascular re -canalization of acute cerebral artery occlusion combined with intracranial aneurysms: an analysis of 7 cases / 中华神经医学杂志

Objective To investigate the safety of endovascular thrombectomy in acute ischemic stroke patients with pre-existing intracranial aneurysms. Methods Seven patients with acute ischemic stroke combined with intracranial aneurysms, admitted to and received endovascular treatment in our hospital from January 2014 to December 2016, were chosen. The clinical data and safety were analyzed retrospectively. Results All patients with pre-existing intracranial aneurysms suffered acute large artery occlusion achieved successful endovascular re-canalization, and one patient suffered subarachnoid hemorrhage due to the rupture of aneurysm during the procedure. Three patients had grading 2b of Thrombolysis in Cerebral Infarction (TICI), and 4 had grading 3 of TICI. Four patients had 0-2 scores of modified Rankin Scale (mRS), one had 3 scores, and two died. Conclusion Endovascular thrombectomy in acute ischemic stroke patients with pre-existing intracranial aneurysms is safe.

Angiographic and Clinical Factors Related with Good Functional Outcome after Mechanical Thrombectomy in Acute Cerebral Artery Occlusion

OBJECTIVE: The aim of this study is to investigate good prognostic factors for an acute occlusion of a major cerebral artery using mechanical thrombectomy. METHODS: Between January 2013 to December 2014, 37 consecutive patients with acute occlusion of a major cerebral artery treated by mechanical thrombectomy with stent retrievers were conducted. We analyzed clinical and angiographic factors retrospectively. The collateral flow and the result of recanalization were sorted by grading systems. Outcome was assessed by National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at 90 days. We compared the various parameters between good and poor angiographic and clinical results. RESULTS: Twenty seven patients demonstrated good recanalization [Thrombolysis in Cerebral Infarction (TICI) 2b or 3] after thrombectomy. At the 90-day follow up, 19 patients had good (mRS, 0-2), 14 had moderate (3-4) and four had poor outcomes (5-6). The mRS of older patients (> or =75 years) were poor than younger patients. Early recanalization, high Thrombolysis in Myocardial Infarction risk score, and low baseline NIHSS were closely related to 90-day mRS, whereas high TICI was related to both mRS and the decrease in the NIHSS. CONCLUSION: NIHSS decreased markedly only when recanalization was successful. A good mRS was related to low initial NIHSS, good collateral, and early successful recanalization.

Critical Use of Balloon Angioplasty after Recanalization Failure with Retrievable Stent in Acute Cerebral Artery Occlusion

OBJECTIVE: Sudden major cerebral artery occlusion often resists recanalization with currently available techniques or can results in massive symptomatic intracranial hemorrhage (sICH) after thrombolytic therapy. The purpose of this study was to examine mechanical recanalization with a retrievable self-expanding stent and balloon in acute intracranial artery occlusions. METHODS: Twenty-eight consecutive patients with acute intracranial artery occlusions were treated with a Solitaire retrievable stent. Balloon angioplasty was added if successful recanalization was not achieved after stent retrieval. The angiographic outcome was assessed by Thrombolysis in Cerebral Infarction (TICI) and the clinical outcomes were assessed by the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). RESULTS: At baseline, mean age was 69.4 years and mean initial NIHSS score was 12.5. A recanalization to TICI 2 or 3 was achieved in 24 patients (85%) after stent retrieval. Successful recanalization was achieved after additional balloon angioplasty in 4 patients. At 90-day follow-up, 24 patients (85%) had a NIHSS improvement of > or =4 and 17 patients (60%) had a good outcome (mRS < or =2). Although there was sICH, there was one death associated with the procedure. CONCLUSION: Mechanical thromboembolectomy with a retrievable stent followed by additional balloon angioplasty is a safe and effective first-line therapy for acute intracranial artery occlusions especially in case of unsuccessful recanalization after stent thrombectomy.