Temporary endovascular bypass: rescue technique during mechanical thrombolysis

Neurosurgery. 2012 Jan;70(1):245-52; discussion 252. doi: 10.1227/NEU.0b013e31822e5a62.

Abstract

Background: The goal of mechanical thrombolysis is to re-establish blood flow to a completely occluded artery in patients who fail intravenous thrombolytic therapy or who are outside the therapeutic window.

Objective: We present our single-institution experience with the use of temporary, partial deployment of a self-expanding intracranial stent as a rescue technique for the treatment of acute stroke. The use of the Enterprise stent represents an off-label use of a humanitarian device exemption device.

Methods: We performed a retrospective review of a prospective database of acute stroke patients treated with intra-arterial techniques at the Thomas Jefferson University Comprehensive Stroke Center from July 2009 to July 2010.

Results: Seven patients were included, and we obtained a 100% recanalization rate to Thrombolysis in Myocardial Infarction grade 2 and 3 with a 28% asymptomatic hemorrhagic transformation. No device-related complications were encountered.

Conclusion: Temporary, partial deployment of a self-expanding intracranial stent as a rescue procedure is feasible, effective, and safe in the setting of endovascular intervention for acute stroke, although our experience is limited. This technique was used only as a rescue procedure when more established procedures failed.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Coronary Angiography
  • Coronary Artery Bypass / methods*
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Male
  • Mechanical Thrombolysis / methods*
  • Middle Aged
  • Retrospective Studies
  • Stents
  • Stroke / therapy*
  • Thrombolytic Therapy
  • Treatment Outcome

Substances

  • Fibrinolytic Agents