Efficacy of Solitaire™ Stent Arterial Embolectomy in Treating Acute Cardiogenic Cerebral Embolism in 17 Patients
Maolin Fu, Wenqin He, Weizheng Dai, Yingan Ye, Zhifang Ruan, Shuanghu Wang, Huifang Xie
(Department of Neurology, The 180th Hospital of PLA, Quanzhou, Fujian, China (mainland))
Med Sci Monit 2016; 22:1302-1308
Thrombolysis with rtPA is the only accepted drug therapy for acute ischemic stroke. Since acute cerebral stroke is so pervasive, newly developed recanalization methods have the potential for wide-ranging impacts on patient health and safety. We explored the efficacy and safety of Solitaire stent arterial embolectomy in the treatment of acute cardiogenic cerebral embolism.
MATERIAL AND METHODS: Between October 2012 and June 2015, 17 patients underwent Solitaire stent arterial embolectomy, either alone or in combination with rtPA intravenous thrombolysis, to treat acute cardiogenic cerebral embolism. Sheath placement time, vascular recanalization time, number of embolectomy attempts, and IV rtPA dose and time were recorded. Success and safety of the recanalization procedure, as well as clinical outcomes, were assessed. These results were compared to 16 control patients who were treated using only rtPA IV thrombolysis.
RESULTS: Full recanalization of the occluded arteries was achieved in 15 (88.2%) of the Solitaire stent patients. NIH Stroke Scale scores of embolectomy patients improved by an average of 12.59±8.24 points between admission and discharge, compared to 5.56±5.96 in the control group (P<0.05). Glasgow Coma Score improvement between admission and discharge was also significantly higher in the embolectomy group (P<0.05). There was no significant difference in symptomatic intracerebral hemorrhage, high perfusion encephalopathy, incidence of hernia, or mortality between the 2 groups (P>0.05).
CONCLUSIONS: Solitaire stent embolectomy is a safe and effective alternative to simple venous thrombolytic therapy, and it can significantly improve short-term neurological function and long-term prognosis in acute cardiogenic cerebral embolism.
Keywords: Aged, 80 and over, Aged, Adult, Arterial Occlusive Diseases - therapy, Brain Ischemia - etiology, Case-Control Studies, Cerebral Hemorrhage - therapy, Embolectomy - methods, Female, Humans, Intracranial Embolism - therapy, Male, Middle Aged, Stents - adverse effects, Stroke - etiology, Thrombolytic Therapy - methods, Treatment Outcome