Abstract 1961: Middle Cerebral Artery Stenting for Acute Ischemic Stroke after Merci Retriever Failure
Background and Purpose: At our institution, intracranial stenting has been used in the treatment of ischemic stroke caused by acute intracranial vessel occlusion after Merci retriever failure. We describe this patient population and the results achieved with adjunctive stenting.
Methods: Patients who had intraarterial therapy for acute ischemic stroke with concomitant use of the Merci retriever between February 1, 2005 and May 2, 2006 were identified from our endovascular database. Cases in which recanalization was not achieved with the retriever (the microcatheter could not be advanced across the lesion or the vessel remained occluded despite passage of this catheter) and in which stenting was attempted as a secondary means of mechanical thrombolysis were retrospectively reviewed.
Results: Eleven patients (mean age, 71.0 years) who failed Merci retrieval underwent stenting with a coronary balloon-mounted or an intracranial self-expanding stent. Mean admission NIHSS score was 15.4. Occlusions treated were located in the middle cerebral artery, with five lesions extending into M2 branches. Eight patients received intraarterial reteplase. Eptifibatide was administered immediately prestenting in every patient. Successful recanalization (TIMI grade 2 or 3) was achieved in 9 patients, with complete recanalization (TIMI grade 3) in 8. Intraprocedural complications were 2 subarachnoid and 1 intracranial hemorrhages (all clinically silent) and 1 reperfusion hemorrhage. Five patients experienced NIHSS score improvement of 4 or more points.
Conclusions: Angiographic recanalization has been associated with improvement in clinical outcome in the setting of acute cerebral ischemia. Recanalization is not always achieved using the Merci retriever. We found stenting useful as an additional treatment option and achieved successful recanalization in 82% of our cohort.