Safety of Angioplasty and Stenting Without Thrombolysis for the Treatment of Early Ischemic Stroke

Strokes from large-vessel atherosclerotic occlusions or severe stenoses are often resistant to re-canalization with thrombolytic agents. As in acute coronary syndromes, angioplasty and stenting for stroke may be used to achieve timely reperfusion with possibly less risk for hemorrhagic complications. From a prospectively collected database, we have retrospectively reviewed cases of patients presenting acutely with an ischemic stroke or subacutely with fluctuating ischemic deficits due to a large-vessel atherosclerotic stenosis and who were treated with angioplasty and stenting without thrombolytics. Endpoints were reperfusion based on the Thrombolysis in Myocardial Infarction (TIMI) score, procedural complications, parenchymal hematoma formation leading to neurologic decline, and 30-day clinical improvement based on the National Institutes of Health Stroke scale (NIHSS). Nine patients with a mean age of 70 +/- 9 years and mean NIHSS of 18.3 +/- 5.0 were treated. Culprit stenotic lesions were located in the extracranial internal carotid artery (ICA) origin (2), intracranial ICA (2), tandem stenosis in the extra- and intracranial ICA (3), and middle cerebral artery (2). Eight patients were treated with angioplasty and adjunctive stenting; one of these patients also required snaring of thrombus from the middle cerebral artery. One patient was treated with angioplasty of an intracranial ICA stenosis alone. TIMI 3 reperfusion was achieved in 8 (88.9%) patients. The mean 30-day improvement in the NIHSS was 15.5 +/- 5.6. Six patients had a NIHSS of 0 or 1 at 30 days. One patient died due to reasons unrelated to stroke or interventional procedure. There were no significant complications or parenchymal hemorrhages. In appropriately selected patients with ischemic deficits due to large artery atherosclerotic stenoses, angioplasty with adjunctive stenting can be safely performed. Such interventions may improve outcome without the use of thrombolysis. J Neuroimaging 2009;19:139-143.