Treatment of acute ischemic stroke: feasibility of primary or secondary use of a self-expanding stent (Neuroform) during local intra-arterial thrombolysis.

introductionWe evaluated the feasibility of employing a self-expanding stent (Neuroform) in treatment of acute cerebral ischemia and compared the results of primary and secondary stenting.

methodsWe analyzed the treatment results of 14 acute ischemic stroke patients (11 men and three women; median age, 65 years) who were treated with Neuroform stents. Seven patients received stent placement for primary recanalization and a further seven for secondary recanalization. We performed between-group comparisons of all of overall procedure duration, recanalization rate immediately after stenting, need for additional measures after stenting, final recanalization rate, occurrence of hemorrhagic transformation, early re-occlusion rate after 24 h, and 3-month functional recovery rate (mRS ≤2).

resultsThe median interval from femoral puncture to stent placement was 61.5 min and was significantly shorter in the primary than in the secondary group (55 vs. 95 min, p = 0.004). The recanalization rate immediately after stenting was 42.9% and was greater in the primary than in the secondary group (71.4% vs. 14.3%, p = 0.1). Thirteen patients required various additional therapeutic measures. The final recanalization rate was 78.6%, attributable to improvements in the recanalization rate of the secondary group (71.4% vs. 85.7%). Early hemorrhagic transformation was noted in four patients, but only one patient became symptomatic (symptomatic hemorrhage, 7.1%). Good functional recovery was noted in eight patients (57.1%).

conclusionPlacement of a self-expanding stent during endovascular recanalization of acute ischemic stroke was both feasible and safe. Primary use of this method may enhance early recanalization.