Intracranial Stenting as a Rescue Therapy in Patients with Stroke-in-Evolution

Background The feasibility and efficacy of intracranial stenting were evaluated for patients with a stroke-in-evolution after the time window for thrombolysis. Methods Patients with symptomatic intracranial steno-occlusive disease with progressive or fluctuating symptoms were treated using intracranial stenting after the time window for hyperacute thrombolysis. Results Within the study period, we identified 10 patients (7 men, 62.5 ± 11.3 years old) who were eligible for inclusion. The median onset-to-arrival time was 5.8 hours (range: .6-144 hours), and the median onset-to-procedure time was 33 hours (range: 8-346 hours). Only 1 patient previously received intravenous thrombolysis using alteplase. The symptomatic occlusive artery was the right middle cerebral artery, left middle cerebral artery, and basilar artery in 3, 1, and 6 patients, respectively. The median initial National Institutes of Health Stroke Scale (NIHSS) score was 4 (range: 0-6), and the median NIHSS score measured immediately before the procedure was 8 (range: 4-26). All but 1 patient underwent successful angioplasty and stenting using a Wingspan stent. Reocclusion of the stented artery occurred in 1 patient, and his neurological status deteriorated to coma. A favorable outcome (modified Rankin Scale ≤2) at 3 months was noted in 7 patients (70%). Conclusion Intracranial stenting could be considered an alternative strategy for treating patients with medically intractable stroke-in-evolution.