Article Figures & Data
Figures
- Fig 1.
Steps involved in sirolimus-eluting stent delivery and deployment. A, A steerable wire is softly advanced through the occlusive clot. B, Placement of stent across occlusion. C, Deployment of stent, thus trapping the occlusion.D, Recanalization.
- Fig 2.
A 69-year-old woman with an NIHSS score of 17 who was noted to have a right hemiplegia and aphasia was given an IV bolus dose of tPA because she presented less than 3 hours from symptom onset. She was transferred on an emergency basis to our institution and referred for IA therapy.
A, Angiography (anteroposterior view) reveals a left M1 MCA occlusion (black arrow) with a large anterior temporal branch.
B, A 3.5- × 20-mm Neuroform 3 stent was deployed across the focal area of occlusion after administering an IV bolus dose of eptifibatide (180 μg/kg). Recanalization (TIMI/TICI 3 flow) was re-established in the posterior division of the MCA (dotted black arrow).
C, An unsubtracted image reveals the proximal and distal edges of the stent (black arrowheads).
D, A follow-up run reveals that the anterior division of the MCA is now also patent, but there are filling defects within the stent (arrow demonstrates filling of branch vessels with a filling defect in one of the branches). The patient improved on the day after the procedure to an NIHSS score of 10.
Tables
NIHSS Improved ≥4 Points in 24 Hours P No Yes Demographics (patients) n = 11 n = 7 Age, years (mean ± SD) 71.3 ± 12.0 81 ± 7.9 .08 Admission NIHSS (mean ± SD) 16.5 ± 5.9 15.8 ± 5.7 .84 Time to angiography, minutes (mean ± SD) 624 ± 918 216 ± 123 .35 Women (men) 4 (7) 6 (1) .05 Comorbidities (patients) n = 11 n = 7 Hypertension 11 6 .39 Diabetes mellitus 2 1 .67 Atrial fibrillation 3 4 .22 Hyperlipidemia 7 1 .05 Coronary artery disease 3 2 .68 Location (lesions) n = 12 n = 7 M1 MCA 2 2 .47 M2 MCA 0 1 .37 VBS 2 1 .70 Any solitary lesion 4 4 .30 M1 MCA + M2 MCA 2 2 .47 ICA bifurcation + ICA terminus + M1 MCA 2 0 .39 ICA bifurcation + M1 MCA 2 1 .70 ICA terminus + M1 MCA 2 0 .39 Limited to MCA (M1 or M2 MCA or M1+M2) 4 5 .13 Limited to MCA or VBS 6 6 .14 Stent used (lesions) n = 12 n = 7 Neuroform 11 5 .29 Wingspan 1 2 .29 Adjunctive treatment (lesions) n = 12 n = 7 IIb/IIIa inhibitor 8 2 .13 IA thrombolysis 8 4 .52 IV thrombolysis 4 1 .37 Merci retriever 4 5 .13 Angioplasty 7 3 .43 Note:—NIHSS indicates National Institutes of Health Stroke Scale; MCA, middle cerebral artery; VBS, vertebrobasilar system; ICA, internal carotid artery; IA, intra-arterial.
TIMI 2–3 Flow P No Yes Demographics (patients) n = 4 n = 14 Age, years (mean ± SD) 67.5 ± 11.6 77.2 ± 10.8 .14 Admission NIHSS (mean ± SD) 15.8 ± 5.2 16.4 ± 6.3 .86 Time to angiography, minutes (mean ± SD) 372 ± 72 509 ± 894 .77 Women (men) 0 (4) 10 (4) .02 Comorbidities (patients) n = 4 n = 14 Hypertension 4 13 .78 Diabetes mellitus 1 2 .55 Atrial fibrillation 2 5 .51 Hyperlipidemia 3 5 .21 Coronary artery disease 0 5 .23 Location (lesions) n = 4 n = 15 M1 MCA 0 4 .35 M2 MCA 0 1 .79 VBS 0 3 .47 Any solitary lesion 0 8 .09 M1 MCA + M2 MCA 0 4 .35 ICA bifurcation + ICA terminus + M1 MCA 2 0 .04 ICA bifurcation + M1 MCA 0 3 .47 ICA terminus + M1 MCA 2 0 .04 Limited to MCA (M1 or M2 MCA or M1+M2) 0 9 .05 Limited to MCA or VBS 0 12 .01 Stent used (lesions) n = 4 n = 15 Neuroform 4 12 .47 Wingspan 0 3 .47 Adjunctive treatment (lesions) n = 4 n = 15 IIb/IIIa inhibitor 3 7 .33 IA thrombolysis 3 9 .53 IV thrombolysis 2 3 .27 Merci retriever 1 8 .33 Angioplasty 1 9 .25 Clinical outcomes (patients) n = 4 n = 14 mRS score ≤ 3 0 6 .16 mRS score ≤ 3 at 3 months 0 4 .42 NIHSS score reduced by ≥ 4 0 7 .11 Note:—TIMI indicates Thrombolysis in Myocardial Infarction; NIHSS, National Institutes of Health Stroke Scale; MCA, middle cerebral artery; VBS, vertebrobasilar system; ICA, internal carotid artery; IA, intra-arterial; mRS, modified Rankin Scale.
- Table 3:
Recanalization by mechanical maneuver with adjunctive pharmacotherapy (such as IIb/IIIa inhibitors)
Recanalization Stent Angioplasty and Stent Merci and Stent Angioplasty, Merci, and Stent Lesions 6 4 3 6 TIMI/TICI 0/1, n (%) 2 (33) 1 (25) 1 (33) 0 (0) TIMI/TICI 2, n (%) 2 (33) 1 (25) 1 (33) 0 (0) TIMI/TICI 3, n (%) 2 (33) 2 (50) 1 (33) 6 (100) TIMI/TICI 2/3, n (%) 4 (66) 3 (75) 2 (66) 6 (100) NIHSS improved ≥4 (% patients) 33 0 66 66 Note:—TIMI indicates Thrombolysis in Myocardial Infarction; TICI, Thrombolysis in Cerebral Ischemia; NIHSS, National Institutes of Health Stroke Scale.
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