Intracranial Stenting as a Rescue Therapy in Patients with Stroke-in-Evolution

Background: The feasibility and efficacy of intracranial stenting were evaluated for patients with a stroke-in-evolution after the time window for thrombolysis. Methods: Patients with symptomatic intracranial steno-occlusive disease with progressive or fluctuating symptoms were treated using intracranial stenting after the time window for hyperacute thrombolysis. Results: Within the study period, we identified 10 patients (7 men, 62.5 +/- 11.3 years old) who were eligible for inclusion. The median onset-to-arrival time was 5.8 hours (range:.6-144 hours), and the median onset-to-procedure time was 33 hours (range: 8-346 hours). Only 1 patient previously received intravenous thrombolysis using alteplase. The symptomatic occlusive artery was the right middle cerebral artery, left middle cerebral artery, and basilar artery in 3, 1, and 6 patients, respectively. The median initial National Institutes of Health Stroke Scale (NIHSS) score was 4 (range: 0-6), and the median NIHSS score measured immediately before the procedure was 8 (range: 4-26). All but 1 patient underwent successful angioplasty and stenting using a Wingspan stent. Reocclusion of the stented artery occurred in 1 patient, and his neurological status deteriorated to coma. A favorable outcome (modified Rankin Scale <= 2) at 3 months was noted in 7 patients (70%). Conclusion: Intracranial stenting could be considered an alternative strategy for treating patients with medically intractable stroke-in-evolution. (C) 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.