Special endovascular treatment for acute large artery occlusion resulting from atherosclerotic disease.

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Special endovascular treatment for acute large artery occlusion resulting from atherosclerotic disease.

World Neurosurg. 2017 Apr 01;:

Authors: Yi TY, Chen WH, Wu YM, Zhang MF, Chen YH, Wu ZZ, Shi YC, Chen BL

Abstract
BACKGROUND: and Purpose: Acute intracranial atherosclerotic disease (IAD)-related large artery occlusion (LAO) is typically refractory to mechanical thrombectomy. We evaluated the feasibility and safety of emergency balloon-assisted or stent-assisted angioplasty performed with tirofiban administration for acute IAD-related LAO.
METHODS: We identified, from among 55 consecutive patients who underwent endovascular treatment for LAO, 12 patients with acute IAD-related LAO who underwent balloon-assisted or stent-assisted angioplasty with (n = 3) or without passage of a stent retriever. The treatment included tirofiban administration. We obtained, from patients' clinical records, TICI scores (to assess the extent of reperfusion), follow-up magnetic resonance angiography images (to assess patency of the responsive arteries), and 90-day modified Rankin (mRS) scores (to assess outcomes).
RESULTS: Temporary blood flow and severe stenosis were observed angiographically in all 12 patients, either when the stent retriever was deployed or when a microcatheter was advanced through the site of occlusion. Persistent recanalization was achieved in all patients, and there was no operative complication or arterial re-occlusion. All 8 patients with an occluded major artery in the anterior circulation had a good outcome, with an mRS score of ≤2. Two of the 4 patients with basilar artery occlusion had a good outcome, with an mRS score of ≤2. One patient (25%) died within 72 hours after procedure.
CONCLUSIONS: Our data point to the safety and feasibility of emergency balloon- or stent-assisted angioplasty performed with tirofiban administration and a single or no passage of the stent retriever for acute IAD-related LAO.

PMID: 28377257 [PubMed - as supplied by publisher]

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