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J Clin Neurol. 2013 Apr;9(2):91-6. doi: 10.3988/jcn.2013.9.2.91. Epub 2013 Apr 4.

A comparison of stent-assisted mechanical thrombectomy and conventional intra-arterial thrombolysis for acute cerebral infarction.

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1
Department of Neurology, Chungnam National University Hospital and School of Medicine, Daejeon, Korea.

Abstract

BACKGROUND AND PURPOSE:

We evaluated whether stent-assisted thrombectomy (SAT) is safer or more clinically beneficial than aggressive mechanical clot disruption (AMCD) for patients with acute intracranial artery occlusion.

METHODS:

We retrospectively analyzed the clinical data of 72 patients (33 with SAT and 39 with AMCD) who underwent intra-arterial thrombolysis for acute intracranial artery occlusions. Procedure parameters, clinical outcomes, and incidence of complications were compared between the SAT and AMCD groups.

RESULTS:

The time interval to recanalization was shorter in SAT patients (69.2±39.6 minutes, mean±standard deviation) than in AMCD patients (94.4±48.0 minutes, p<0.05). Recanalization was achieved in more SAT patients (91%) than AMCD patients (80%), but with no statistically significance. Urokinase was used less frequently in SAT patients (21%) than in AMCD patients (92%, p<0.05), and the incidence of symptomatic hemorrhages was lower in SAT patients (3%) than in AMCD patients (18%, p<0.05). Device-related complications in SAT patients comprised two cases of stent fracture and one case of distal migration of a captured thrombus. The proportion of patients with good outcomes, defined as scores from 0 to 3 on the modified Rankin Scale, was similar in the two groups at discharge (SAT, 46%; AMCD, 39%), but significantly higher in the SAT group than in the AMCD group at 3 months (64% vs. 40%, p<0.05) and 6 months (67% vs. 42%, p<0.05) after discharge.

CONCLUSIONS:

The outcomes and clinical parameters were better for SAT during thrombolytic procedures for acute intracranial artery occlusions than for AMCD for up to 6 months. However, some device-related complications occurred during stent interventions.

KEYWORDS:

acute stroke; mechanical thrombolysis; stent-assisted thrombectomy

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