Image-based visualization of stents in mechanical thrombectomy for acute ischemic stroke: Preliminary findings from a series of cases

Qing-Yang Yao; Mao-Lin Fu; Qing Zhao; Xiao-Ming Zheng; Kai Tang; Li-Ming Cao

doi:10.12998/wjcc.v11.i21.5047

Image-based visualization of stents in mechanical thrombectomy for acute ischemic stroke: Preliminary findings from a series of cases

World J Clin Cases. 2023 Jul 26;11(21):5047-5055. doi: 10.12998/wjcc.v11.i21.5047.

Authors

Qing-Yang Yao¹, Mao-Lin Fu², Qing Zhao², Xiao-Ming Zheng², Kai Tang², Li-Ming Cao^{3

4}

Affiliations

¹ Department of Neurology, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China.
² Department of Neurology, The 910 Hospital of the Joint Logistics Support Force of the Chinese PLA, Quanzhou 362000, Fujian Province, China.
³ Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China.
⁴ Hunan Provincial Key Laboratory of The Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha 410219, Hunan Province, China. caolm-2007@163.com.

Abstract

Background: Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window. Typically, an arteriogram does not show the localization of the stent after release and whether a thrombus is captured or not. Thus, improving the visualization of a stent in interventional therapy will be helpful for clinicians.

Aim: To analyze stent imaging findings to enhance clinicians' understanding of a special circumstance, wherein a Solitaire AB retrievable stent was visible during the imaging of a thrombus capture that improved the success rate of stent-based mechanical thrombectomy.

Methods: This was a retrospective study with four acute ischemic stroke (AIS) patients who underwent stent-based mechanical thrombectomy.

Results: Patient 1 was a 64-year-old man admitted after 5 h of confusion; angiography revealed basilar artery occlusion. We inserted a stent into the left posterior cerebral artery-P2 segment and visualized the expanded stent that successfully captured a thrombus. Patient 2 was a 74-year-old man admitted with confusion, which lasted approximately 3 h. Angiography revealed a left middle cerebral artery (MCA)-M1 segment occlusion. A stent was deployed in the distal M2 segment, and we could visualize the stent by capturing the thrombus. Patient 3 was a 74-year-old woman admitted after experiencing left hemiplegia for 3 h. We deployed a stent at the distal right MCA-M2 segment, and the developing stent captured a large thrombus. Patient 4 was an 82-year-old man who presented with confusion for 3 h. A developing stent was placed in the distal left MCA-M1 segment, which captured a large thrombus and several fragmented thrombi.

Conclusion: To the best of our knowledge, this is the first report of stent imaging in patients with AIS. We demonstrated the usefulness and substantial potential of stent imaging in stent-based mechanical thrombectomy for AIS.

Keywords: Acute ischemic stroke; Digital subtraction angiography; Solitaire AB stent; Stent-based mechanical thrombectomy; Visualization of stents.