Recanalization with stent-based mechanical thrombectomy in anterior circulation major ischemic stroke

J Clin Neurosci. 2012 Jan;19(1):39-43. doi: 10.1016/j.jocn.2011.06.015. Epub 2011 Dec 1.


We report the use of a self-expanding stent as a thrombectomy device in 17 patients (mean age 64.3 years) with major ischemic stroke secondary to large vessel occlusion. The patients had a mean National Institutes of Health Stroke Scale (NIHSS) score of >12, no cerebral hemorrhage or early infarction signs that affected more than 1/3 of the endangered territory, and an insufficient collateral supply. Within 8 hours of symptom onset, a stent (Solitaire; ev3, Irvine, CA, USA) was deployed across the occluded segment (endovascular bypass step). A repeat angiogram was performed to evaluate reconstituted flow. The guide-catheter balloon was inflated for proximal carotid occlusion. The partially deployed stent was slowly pulled back (mechanical thrombectomy step) under continuous aspiration. Complete recanalization (TIMI grade 3 flow) was achieved in fewer than 66 minutes after femoral access in all patients, with complete clot removal in a mean of two thrombectomy attempts. No stent was permanently implanted. Two patients developed asymptomatic hemorrhagic transformation (11.8%). Two patients presented post-recanalization parenchymal hemorrhage (11.8%); one suffered an intracerebral and intraventricular hemorrhage 12 hours after a successful and uneventful procedure and died 10 days later. The modified Rankin Scale scores were 0 to 2 in 15 patients (88.2%) and 3 in one patient (5.9%) at 1 month. In our preliminary experience, rapid stent-based mechanical thrombectomy has had unprecedented success.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angioplasty / instrumentation
  • Angioplasty / methods*
  • Brain Infarction / pathology
  • Brain Infarction / physiopathology
  • Brain Infarction / therapy*
  • Brain Ischemia / pathology
  • Brain Ischemia / physiopathology
  • Brain Ischemia / therapy*
  • Female
  • Humans
  • Male
  • Mechanical Thrombolysis / instrumentation
  • Mechanical Thrombolysis / methods*
  • Middle Aged
  • Stents / standards*
  • Stents / statistics & numerical data