LOS ANGELES – Using retrievable stents to remove occluding clots from the cerebral arteries of acute, ischemic-stroke patients produced a high rate of recanalization and good safety in 3-month follow-up of 74 patients, the largest series of stroke patients treated this way yet reported.
Removing clots from acute stroke patients using retrievable stents also required less time and fewer passes, with an average procedure duration of 45 minutes, Dr. Aitziber Aleu said at the International Stroke Conference.
Dr. Aitziber Aleu
"The advantage of stentrievers [retrievable stents] is that they are very easy to use and are faster to recanalize with fewer passes," said Dr. Aleu, an interventional neurologist at Germans Trias i Pujol University Hospital, Barcelona. "You get the vessel open faster, compared with some of the older devices, and you get higher recanalization rates." Retrievable stents "are now our first-line approach for acute stroke patients," she said in an interview.
The series of 89 patients she reported underwent treatment with a retrievable stent at Hospital Germans Trias i Pujol or one of two other hospitals in the Barcelona area during March 2008 to December 2010. The operators used either of two different brands of retrievable stents, the Solitaire or the Trevo, on roughly equal numbers of patients.
The average age of the 89 patients in the reported series was 66 years, and their average NIH Stroke Scale score at baseline was 18, ranging from 15-22. Prior to stent placement, 48% of the patients had received treatment with tissue plasminogen activator. The most common location of the occluding clot was in the M1 segment of the middle cerebral artery, in 44% of patients. The occluding clot occurred in the vertebrobasilar artery in 15%, the terminal region of the interior cerebral artery in 14%, and 14% of patients had tandem occlusions in both the proximal region of the internal cerebral artery and in the middle cerebral artery.
The average recanalization procedure took 45 minutes, with a range of 27-60 minutes, and each procedure required an average of 1.4 stent passes to remove the occluding blood clot. Stent deployment usually lasted less than a minute before retrieval, and the operators had no episodes of failed deployment. Stent treatment resulted in successful recanalization in 81 patients (91%), with 70% achieving a Thrombolysis in Cerebral Infarction flow rate of III, and 21% achieving TICI II flow.
The investigators identified neurologic improvement 1 day after treatment in 28 patients (32%), and by 1 week after treatment 6 patients (7%) had died.
When she made her report, Dr. Aleu had 3-month follow-up results for 74 patients. At that time, 35 patients (47%) had a modified Rankin score of 2 or less, and 15 patients (20%) had died. During 3-month follow-up, 9% of the 74 patients had a symptomatic intracerebral hemorrhage.
Dr. Aleu said that she and her associates on the study had no disclosures.