Clinical Study Recanalization with stent-based mechanical thrombectomy in anterior circulation major ischemic stroke José E. Cohen a,b,⇑ , John M. Gomori b , Ronen R. Leker c , Samuel Moscovici a , Fernando Ramirez-deNoriega a , Eyal Itshayek a a Department of Neurosurgery, Hadassah–Hebrew University Medical Center, Ein-Kerem, P.O. Box 12000, Jerusalem 91120, Israel b Department of Radiology, Hadassah–Hebrew University Medical Center, Jerusalem, Israel c Department of Neurology, Hadassah–Hebrew University Medical Center, Jerusalem, Israel article info Article history: Received 19 June 2011 Accepted 26 June 2011 Keywords: Bypass Stent Stroke Thrombectomy Thrombolysis abstract We report the use of a self-expanding stent as a thrombectomy device in 17 patients (mean age 64.3 years) with major ischemic stroke secondary to large vessel occlusion. The patients had a mean National Institutes of Health Stroke Scale (NIHSS) score of >12, no cerebral hemorrhage or early infarction signs that affected more than 1/3 of the endangered territory, and an insufficient collateral supply. Within 8 hours of symptom onset, a stent (Solitaire; ev3, Irvine, CA, USA) was deployed across the occluded seg- ment (endovascular bypass step). A repeat angiogram was performed to evaluate reconstituted flow. The guide-catheter balloon was inflated for proximal carotid occlusion. The partially deployed stent was slowly pulled back (mechanical thrombectomy step) under continuous aspiration. Complete recanaliza- tion (TIMI grade 3 flow) was achieved in fewer than 66 minutes after femoral access in all patients, with complete clot removal in a mean of two thrombectomy attempts. No stent was permanently implanted. Two patients developed asymptomatic hemorrhagic transformation (11.8%). Two patients presented post-recanalization parenchymal hemorrhage (11.8%); one suffered an intracerebral and intraventricular hemorrhage 12 hours after a successful and uneventful procedure and died 10 days later. The modified Rankin Scale scores were 0 to 2 in 15 patients (88.2%) and 3 in one patient (5.9%) at 1 month. In our pre- liminary experience, rapid stent-based mechanical thrombectomy has had unprecedented success. Ó 2011 Elsevier Ltd. All rights reserved. 1. Introduction Stenting is a promising option for the treatment of acute cere- bral ischemia secondary to large vessel arterial occlusion. 1,2 The main advantage of stenting in this setting is rapid recanalization with high technical success rates. The ‘‘temporary endovascular bypass’’ technique has been used recently to avoid the long-term complications of stenting. 3,4 A stent is deployed and then recap- tured after vessel recanalization has been successful. The use of a stent itself as a thrombectomy device-represents a step forward in the treatment of ischemic stroke. 5–8 Mechanical thrombectomy, a relatively new concept of inter- ventional stroke treatment, is rapidly replacing selective intra- arterial fibrinolysis. The principle is based on rapid removal of the clot instead of slow pharmacological disintegration of the em- bolic material after intra-arterial injection by different devices. 9 Mechanical thrombectomy has led to a significant increase in recanalization rates, with an accelerated recanalization process that reduces recanalization times. It has expanded the therapeutic window and the target population, reduced the rate of hemor- rhagic complications, and improved overall neurological progno- sis. 9–13 Thus, we present our recent experience of successful recanaliza- tion of anterior circulation large artery occlusion using a stent as a thrombectomy device in a consecutive series of 17 patients. 2. Material and methods This study included 17 consecutive patients with large vessel acute ischemic stroke who were treated with self-expanding stents to achieve temporary endovascular bypass and as a thrombectomy device (Solitaire; ev3, Irvine, CA, USA), at a single institution (Hadassah–Hebrew University Medical Center) between March 2010 and May 2011. The 17 patients included six women and 11 men (Table 1), with a mean age of 64.3 years (range 35–92 years). Nine patients presented with atrial fibrillation as a known premorbid condition. All patients presented with major ischemic stroke secondary to large vessel occlusion shown on admission cranial CT scans, including CT angiography. 0967-5868/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.jocn.2011.06.015 ⇑ Corresponding author. Tel.: +972 2 6777092. E-mail address: jcohenns@yahoo.com (J.E. Cohen). Journal of Clinical Neuroscience 19 (2012) 39–43 Contents lists available at SciVerse ScienceDirect Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn