Ces radiol. 2013, 67(2):135-141

The safety and effectiveness of mechanical thrombectomy using the Solitaire AB stent performed as soon as possible after initial intravenous thrombolysis in patients with acute ischemic strokeOriginal article

Martin Köcher¹, Daniel Šaňák², Marie Černá¹, Stanislav Buřval¹, Vojtěch Prášil¹, Tomáš Veverka², Michal Král²

¹ Radiologická klinika, Komplexní cerebrovaskulární centrum LF UP a FN, Olomouc

² Neurologická klinika, Komplexní cerebrovaskulární centrum LF UP a FN, Olomouc

Aim: Ischemic stroke is today one of the leading causes of mortality and morbidity and affects even a younger population of working age. A key factor influencing prognosis after ischemic stroke is early recanalization of close cerebral artery and reperfusion in the affected brain tissue. The aim of our study is to evaluate the safety and effectiveness of revascularization combined therapy consisting of initial intravenous thrombolysis and immediately after that performed mechanical thrombectomy in the treatment of patients with acute ischemic stroke.

Methods: Consecutive non-selected acute ischemic stroke patients with baseline CTA or MRA documented occlusion of middle cerebral artery (MCA) (segment M1-2) or distal part of internal carotid artery (ICA) or basilar artery (BA) and treated between June 2010 and April 2012 at our stroke center were included in the study.
All patiens were treated by combined therapy consisting of initial intravenous thrombolysis and immediately after that performed mechanical thrombectomy by Solitaire stent.
Stroke severity was assessed using National Institutes of Health Stroke Scale (NIHSS), 90-day clinical outcome using modified Rankin Scale (mRS).

Results: Fifty enrolled patients (mean age 66.8 ± 14.6 years) had baseline median NIHSS 18.0 (8-32). Overall recanalization (TICI 2A, B and 3) was achieved in 94 % of patients, complete (TICI 3) in 72% of patients. The mean time from stroke onset-to-maximal recanalization was 244.2 ± 87.9 min. Symptomatic intracerebral hemorrhage occurred in 6% of patients. The median mRS score at 90 days was 1 and 60% patients had good outcome (mRS 0-2). Overall 3-month mortality was 14%.

Conclusion: Combined revascularization therapy of acute ischemic stroke consisting of initial intravenous thrombolysis and immediately after that performed mechanical thrombectomy is safe and effective. Immediate performing of the mechanical thrombectomy after initial intravenous thrombolysis leads to a significant reduction of recanalization time, which is critical for good clinical outcome in patients treated for acute ischemic stroke.

Keywords: acute ischemic stroke, mechanical thrombectomy, Solitaire stent retrieval, thrombolysis

Grants and funding:

Práce je podporována grantem IGA UP v Olomouci LF-2013-002.

Accepted: April 19, 2013; Published: June 1, 2013  Show citation