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Il Giornale Italiano di Radiologia Medica 2018 Maggio-Giugno;5(3):320-4

DOI: 10.23736/S2283-8376.18.00060-8


language: Italian

Endovascular therapy in the acute ischemic stroke. A single-center experience

Vladimir GAVRILOVIC, Andrea PELLEGRIN , Alessandro VIT, Benedetto PETRALIA, Massimo SPONZA

SOC Diagnostica Angiografica e Radiologia Interventistica, S. Maria della Misericordia Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italia


BACKGROUND: The aim of this study was to evaluate periprocedural safety and efficacy of endovascular treatment in patients with acute ischemic stroke and severe neurological deficit (National Institutes of Health Stroke Scale score [NIHSS]=10), with or without previous intravenous (IV) therapy with recombinant tissue plasminogen activator (rtPA).
METHODS: From January 2015 to January 2016, 33 patients (18F, 15M, average age 64.35±13.65years), with cerebral artery thrombosis (28 patients. anterior circulation, 5Pt. posterior circulation) underwent endovascular thrombectomy (<6/8 hours). All 33 patients were evaluated by CT; cerebral artery thrombosis was confirmed on angio-CT; control brain scan was performed at 24 hours (or earlier if It was necessary) and repeated during hospitalization.
RESULTS: Intrarterial mechanical thrombectomy (IA) done with stent retriever or large bore aspiration catheter was technically feasible in 32 patients, preliminary cerebral angiography study was crucial in evaluation of collateral circulation. Fifteen patients have been treated with IV tPA ≤4.5 hours from the start of stroke, before IA thrombectomy. In 16 patients IV tPA treatment was not indicated and IA thrombectomy with possible intracranial stent implantation was the only treatment. Three patients had tandem lesions (carotid and ipsilateral cerebral artery occlusion). Twenty-eight patients received conscious sedation, while 5 patients were treated in general anesthesia. All patients were selected by SPREAD recommendations.
CONCLUSIONS: NIHSS Score reduction for 6.2±6.1 of IA group and 12.6±6.5 of IA + IV group, shows the effectiveness of mechanical thrombectomy. A percentage of 46% of all patients had functional independence (modified Rankin Scale Score ≤2) at hospital discharge. The ideal therapy of acute ischemic stroke is achieved by early recanalization, that results with a good clinical outcome.

KEY WORDS: Stroke - Mechanical thrombolysis, Thrombolytic therapy - Cerebral angiography

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