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- cerebral blood flow
- cerebrovascular disease
- clinical neurology
Intravenous recombinant tissue plasminogen activator (rTPA) therapy has limited recanalisation-rates in large artery occlusions (nadir of 5.9% in Carotid-T-Occlusions).1 Therefore, we prospectively evaluated the Solitaire stent (versions AB and FR, ev3 Inc., Plymouth, Minnesota, USA) in mechanical thrombectomy in acute ischaemic stroke.
Materials and methods
Acute stroke patients were triaged on admission for potential mechanical thrombectomy.
– Age ≤80
– NIHSS score ≥10, less if symptoms were fluctuating
– Onset-to-treatment-time ≤4.5 h or secondary worsening (increase in NIHSS score ≥4). When symptom onset was unclear, patients were eligible if there was mismatch between symptoms and CT-scan
– Any brainstem syndrome.
– Cerebral haemorrhage. Acute infarction >1/3 of middle cerebral artery (MCA) territory on CT-scan.
– Prestroke modified Rankin Scale (mRS) score ≥4
Eligible patients had immediate CT-angiography without delaying intravenous rTPA-thrombolysis if applicable according to the guidelines of the German Neurological Society (DGN). In case of occlusion of either the internal carotid artery (ICA), the MCA-M1-segment or the basilar artery (BA) mechanical thrombectomy was carried out. Up to four clot extraction maneuvers were performed. Any preceding stenosis was a priori stented. These patients received intravenous eptifibatide for 24 h to prevent in-stent-thrombosis; its short half-life would allow for emergency decompressive craniectomy. Combination of rTPA and eptifibatide is safe.2
NIHSS and mRS scores were assessed on admission and …
Competing interests None.
Ethics approval This study was conducted with the approval of the Institutional Ethics Board.
Provenance and peer review Not commissioned; externally peer reviewed.