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Adjuvant Tirofiban Injection Through Deployed Solitaire Stent As a Rescue Technique After failed Mechanical Thrombectomy in Acute Stroke.

Seo JH, Jeong HW, Kim ST, Kim EG - Neurointervention (2015)

Bottom Line: Three patients without successful recanalization after rescue method received angioplasty with stenting.Overall, successful recanalization (TICI grades 2b and 3) was achieved in 17 (94.4%) of 18 patients.Good functional outcome (mRS ≤ 2) was achieved in 9 patients (50.0%) at 3 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Busan Paik Hospital, School of Medicine, Inje University, Busan, Korea.

ABSTRACT

Purpose: We present our experiences of intra-arterial tirofiban injection through a deployed Solitaire stent as a rescue therapy after failed mechanical thrombectomy in patients with acute ischemic stroke.

Materials and methods: Data on 18 patients treated with adjunctive tirofiban injection through a temporarily deployed Solitaire stent after failed mechanical thrombectomy were retrospectively reviewed. Solitaire stent was used as a primary thrombectomy device in 16 of 18 patients. Two patients received manual aspiration thrombectomy initially. If initial mechanical thrombectomy failed, tirofiban was injected intra-arterially through the deployed Solitaire stent and then subsequent Solitaire thrombectomy was performed.

Results: Fourteen patients had occlusions in the middle cerebral artery, 2 in the distal internal carotid artery, and 2 in the basilar artery. Successful recanalization was achieved in 14 patients (77.7%) after intra-arterial injection of tirofiban and subsequent Solitaire thrombectomy. Three patients without successful recanalization after rescue method received angioplasty with stenting. Overall, successful recanalization (TICI grades 2b and 3) was achieved in 17 (94.4%) of 18 patients. Periprocedural complications occurred in 5 patients: distal migration of emboli in 5 patients and vessel perforation in 1. Three patients died. Good functional outcome (mRS ≤ 2) was achieved in 9 patients (50.0%) at 3 months.

Conclusion: Rescue intra-arterial injection of tirofiban through a temporarily deployed Solitaire stent may facilitate further recanalization in cases of failed mechanical thrombectomy in patients with acute ischemic stroke.

No MeSH data available.


Related in: MedlinePlus

Adjuvant tirofiban injection through a deployed solitaire stent in a patient with acute MCA occlusion. A. Cerebral angiography showed complete occlusion of the left MCA (white arrow). Two attempts with mechanical thrombectomy using Solitaire stent (black arrow) failed. B. Third mechanical thrombectomy using Solitaire stent was attempted. C. After injection of 0.5 mg of tirofiban for 5 minutes through a deployed Solitaire stent, angiogram shows increased blood flow through the occluded segment. Then, the Solitaire stent was retrieved. D. Final angiogram shows successful recanalization of the occluded left MCA.
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Figure 1: Adjuvant tirofiban injection through a deployed solitaire stent in a patient with acute MCA occlusion. A. Cerebral angiography showed complete occlusion of the left MCA (white arrow). Two attempts with mechanical thrombectomy using Solitaire stent (black arrow) failed. B. Third mechanical thrombectomy using Solitaire stent was attempted. C. After injection of 0.5 mg of tirofiban for 5 minutes through a deployed Solitaire stent, angiogram shows increased blood flow through the occluded segment. Then, the Solitaire stent was retrieved. D. Final angiogram shows successful recanalization of the occluded left MCA.

Mentions: A Prowler select plus catheter (Codman & Shurtleff, Inc., Raynham, Massachusetts) with a Synchro 0.014 microguidewire (Stryker, Fremont, California) was navigated distal to the thrombus. Then Solitaire stent was deployed across the clot. The stent was kept deployed for 5 or 10 minutes before retrieving it. The partial re-sheathed Solitaire stent and the delivery microcatheter were gently withdrawn through the guiding catheter. While retrieving, proximal aspiration with a 50 cc syringe was performed through the guiding catheter. Immediate follow-up cerebral angiography was performed to assess recanalization. When one or more attempts of mechanical thrombectomy using Solitaire stent were failed, adjuvant injection of tirofiban through deployed Solitaire stent as a rescue method. Adjuvant tirofiban was injected 0.1 mg per a minute through microcatheter holding Solitaire stent. Then Solitaire stent and delivery microcatheter was withdrawn. Failure of initial thrombectomy was determined by individual operator's discretion. Example of the procedure is presented in figure 1. If successful recanalization did not occur, Solitaire thrombectomy was repeated according to operator's discretion.


Adjuvant Tirofiban Injection Through Deployed Solitaire Stent As a Rescue Technique After failed Mechanical Thrombectomy in Acute Stroke.

Seo JH, Jeong HW, Kim ST, Kim EG - Neurointervention (2015)

Adjuvant tirofiban injection through a deployed solitaire stent in a patient with acute MCA occlusion. A. Cerebral angiography showed complete occlusion of the left MCA (white arrow). Two attempts with mechanical thrombectomy using Solitaire stent (black arrow) failed. B. Third mechanical thrombectomy using Solitaire stent was attempted. C. After injection of 0.5 mg of tirofiban for 5 minutes through a deployed Solitaire stent, angiogram shows increased blood flow through the occluded segment. Then, the Solitaire stent was retrieved. D. Final angiogram shows successful recanalization of the occluded left MCA.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4355642&req=5

Figure 1: Adjuvant tirofiban injection through a deployed solitaire stent in a patient with acute MCA occlusion. A. Cerebral angiography showed complete occlusion of the left MCA (white arrow). Two attempts with mechanical thrombectomy using Solitaire stent (black arrow) failed. B. Third mechanical thrombectomy using Solitaire stent was attempted. C. After injection of 0.5 mg of tirofiban for 5 minutes through a deployed Solitaire stent, angiogram shows increased blood flow through the occluded segment. Then, the Solitaire stent was retrieved. D. Final angiogram shows successful recanalization of the occluded left MCA.
Mentions: A Prowler select plus catheter (Codman & Shurtleff, Inc., Raynham, Massachusetts) with a Synchro 0.014 microguidewire (Stryker, Fremont, California) was navigated distal to the thrombus. Then Solitaire stent was deployed across the clot. The stent was kept deployed for 5 or 10 minutes before retrieving it. The partial re-sheathed Solitaire stent and the delivery microcatheter were gently withdrawn through the guiding catheter. While retrieving, proximal aspiration with a 50 cc syringe was performed through the guiding catheter. Immediate follow-up cerebral angiography was performed to assess recanalization. When one or more attempts of mechanical thrombectomy using Solitaire stent were failed, adjuvant injection of tirofiban through deployed Solitaire stent as a rescue method. Adjuvant tirofiban was injected 0.1 mg per a minute through microcatheter holding Solitaire stent. Then Solitaire stent and delivery microcatheter was withdrawn. Failure of initial thrombectomy was determined by individual operator's discretion. Example of the procedure is presented in figure 1. If successful recanalization did not occur, Solitaire thrombectomy was repeated according to operator's discretion.

Bottom Line: Three patients without successful recanalization after rescue method received angioplasty with stenting.Overall, successful recanalization (TICI grades 2b and 3) was achieved in 17 (94.4%) of 18 patients.Good functional outcome (mRS ≤ 2) was achieved in 9 patients (50.0%) at 3 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Busan Paik Hospital, School of Medicine, Inje University, Busan, Korea.

ABSTRACT

Purpose: We present our experiences of intra-arterial tirofiban injection through a deployed Solitaire stent as a rescue therapy after failed mechanical thrombectomy in patients with acute ischemic stroke.

Materials and methods: Data on 18 patients treated with adjunctive tirofiban injection through a temporarily deployed Solitaire stent after failed mechanical thrombectomy were retrospectively reviewed. Solitaire stent was used as a primary thrombectomy device in 16 of 18 patients. Two patients received manual aspiration thrombectomy initially. If initial mechanical thrombectomy failed, tirofiban was injected intra-arterially through the deployed Solitaire stent and then subsequent Solitaire thrombectomy was performed.

Results: Fourteen patients had occlusions in the middle cerebral artery, 2 in the distal internal carotid artery, and 2 in the basilar artery. Successful recanalization was achieved in 14 patients (77.7%) after intra-arterial injection of tirofiban and subsequent Solitaire thrombectomy. Three patients without successful recanalization after rescue method received angioplasty with stenting. Overall, successful recanalization (TICI grades 2b and 3) was achieved in 17 (94.4%) of 18 patients. Periprocedural complications occurred in 5 patients: distal migration of emboli in 5 patients and vessel perforation in 1. Three patients died. Good functional outcome (mRS ≤ 2) was achieved in 9 patients (50.0%) at 3 months.

Conclusion: Rescue intra-arterial injection of tirofiban through a temporarily deployed Solitaire stent may facilitate further recanalization in cases of failed mechanical thrombectomy in patients with acute ischemic stroke.

No MeSH data available.


Related in: MedlinePlus