Related Experiment Video
Updated: Jul 15, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Self-expanding stents for recanalization of acute cerebrovascular occlusions
1Department of Neurosurgery, University at Buffalo, Kaleida Health/Millard Gates Hospital, Buffalo,NY 14209, USA. elevy@buffns.com
Insights
Self-expanding intracranial stents show feasibility for acute stroke treatment, achieving high recanalization rates, especially for single-vessel occlusions. This method offers improved outcomes, particularly in women.
Area of Science:
- Neuroendovascular therapy
- Interventional neurology
- Cerebrovascular disease management
Background:
- Stent-assisted revascularization improves recanalization rates for difficult vessel occlusions.
- Intracranial self-expanding stents offer enhanced flexibility and safety compared to balloon-mounted stents.
Purpose of the Study:
- To evaluate the effectiveness of self-expanding stents for recanalizing acute cerebrovascular occlusions.
- To assess preliminary outcomes of using self-expanding stents in stroke patients.
Main Methods:
- Retrospective review of 18 patients (19 lesions) with acute intracranial artery occlusions.
- Deployment of self-expanding stents, with or without prior pharmacologic/mechanical interventions.
- Administration of GP IIb/IIIa inhibitors in 10 cases to prevent in-stent thrombosis.
Main Results:
- Technical success (stent deployment) achieved in all cases.
- Angiographic success (TICI/TIMI 2/3 recanalization) in 79% of lesions (15/19).
- Higher recanalization rates for single-vessel lesions (8/8) compared to complex lesions (7/11).
- No intraprocedural complications; 7 in-hospital deaths.
- Significant clinical improvement (NIHSS, mRS) observed in some patients, with a trend favoring women.
Conclusions:
- Self-expanding stents are feasible for treating acute symptomatic intracranial occlusions.
- Stent placement with GP IIb/IIIa inhibitors achieved high recanalization rates, particularly for single-vessel lesions.
- Outcomes suggest potential for improved revascularization and clinical results compared to other thrombolytic methods.
Background And Purpose:
Stent-assisted revascularization increases prevailing recanalization rates ( congruent with 50%-69%) for vessel occlusions recalcitrant to thrombolytics. Although balloon-mounted coronary stents can displace thrombus (via angioplasty) and retain clot along vessel walls, intracranial self-expanding stents are more flexible and exert less radial outward force during deployment, increasing deliverability and safety. To understand the effectiveness of self-expanding stents for recanalization of acute cerebrovascular occlusions, we retrospectively reviewed our preliminary experience with these stents.
Materials And Methods:
Eighteen patients (19 lesions) presenting with a clinical diagnosis of acute stroke underwent catheter-based angiography documenting focal occlusion of an intracranial artery. A self-expanding stent was delivered to the occlusion and deployed. Stent placement was the initial mechanical maneuver in 6 cases; others involved a combination of pharmacologic and/or mechanical maneuvers prestenting. GP IIb/IIIa inhibitors were administered in 10 cases intraprocedurally or immediately postprocedurally to avoid acute in-stent thrombosis.
Results:
Stent deployment at the target occlusion (technical success) was achieved in all cases. Thrombolysis in Cerebral Ischemia (TICI)/Thrombolysis in Myocardial Ischemia (TIMI) 2/3 recanalization (angiographic success) was achieved in 15 of 19 lesions (79%). All single-vessel lesions (n=8) were recanalized, but only 7 of 11 combination internal carotid artery and middle cerebral artery lesions were recanalized. No intraprocedural complications occurred. Seven in-hospital deaths occurred: stroke progression, 4; intracranial hemorrhage, 2; respiratory failure, 1. Seven patients had >or=4-point National Institutes of Health Stroke Scale improvement within 24 hours after the procedure, 6 had modified Rankin Score (mRS)
Conclusion:
Feasibility of self-expanding stents for treatment of acute symptomatic intracranial occlusions is shown. For single-vessel lesions, stent placement with concomitant administration of IIb/IIIa inhibitors contributed to the achievement of recanalization rates exceeding those currently reported for other means of thrombolysis.
