Thrombectomy with Solitaire stent for treating acute middle cerebral artery occlusion

Abstract

Objective To assess the efficacy and safety of thrombectomy with Solitaire stent for treatment of acute middle cerebral artery occlusion (MCAO), and to identify the predictive factors for clinical outcome.  Methods A total of 25 patients with acute middle cerebral artery (MCA)-M1 segment occlusion were treated by thrombectomy with Solitaire stent. Time from onset to femoral artery puncture, time from femoral artery puncture to recanalization, times of thrombectomy, thrombolytic therapy or not, balloon dilatation and/or stent implantation, intraarterial thrombolysis or not, tirofiban treatment after therapy or not were recorded. Vascular recanalization immediately after procedure was evaluated by Thrombolysis in Cerebral Infarction (TICI). National Institutes of Health Stroke Scale (NIHSS) was used to evaluate neurological function of patients 24 h after operation, and the clinical outcomes were assessed by modified Rankin Scale (mRS) at 90 d after treatment. The occurrence rate of symptomatic intracranial hemorrhage within 24 h after operation and mortality within 90 d after treatment were recorded.  Results Median time from onset to femoral artery puncture was 5.00 (4.00, 6.30) h; median time from femoral artery puncture to recanalization was 2.00 (2.00, 2.50) h; times of thrombectomy was 2 (2, 2); 7 patients (28%) received intravenous thrombolysis before thrombectomy; 6 patients (24%) underwent balloon dilatation only; 3 patients (12%) underwent stent implantation only; 4 patients (16%) underwent balloon dilatation and stent implantation; 4 patients (16%) received intraarterial thrombolysis after thrombectomy; 11 (44%) received tirofiban therapy after operation. There were 20 patients (80% ) of recanalization with TICI 2b-3 grade. The NIHSS score at 24 h after operation was significantly decreased than before procedure [8 (4, 12) score vs. 14 (11, 17) score; Z = -3.532, P = 0.000]. Symptomatic intracranial hemorrhage occurred in 3 patients (12%). At 90 d after treatment, 15 patients (60%) had favorable prognosis (mRS ≤ 2 score). Two patients (8%) died. Univariate and multivariate forward Logistic regression analysis showed the TICI 2b-3 grade was independent factor for favorable prognosis (OR = 0.316, 95% CI: 0.102-0.982; P = 0.046).  Conclusions Thrombectomy with Solitaire stent is safe and effective for treating acute MCAO. With the increase of TICI grade, the prognosis is better.

DOI: 10.3969/j.issn.1672-6731.2017.11.004