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Neuroradiology
Published in: Neuroradiology 4/2008

01-04-2008 | Interventional Neuroradiology

Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions

Authors: Raul G. Nogueira, Lee H. Schwamm, Ferdinando S. Buonanno, Walter J. Koroshetz, Albert J. Yoo, James D. Rabinov, Johnny C. Pryor, Joshua A. Hirsch

Published in: Neuroradiology | Issue 4/2008

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Abstract

Introduction

The use of coronary balloons in the cerebral vasculature is limited due to their poor trackability and increased risk of vessel injury. We report our experience using more compliant elastomer balloons for thrombus resistant to intraarterial (IA) pharmacological and mechanical thrombolysis in acute stroke.

Methods

We retrospectively analyzed 12 consecutive patients with an occluded intracranial artery treated with angioplasty using a low-pressure elastomer balloon. Angiograms were graded according to the Thrombolysis in Cerebral Infarction (TICI) and Qureshi grading systems. Outcomes were categorized as independent (modified Rankin scale, mRS, score ≤2), dependent (mRS score 3–5), or dead (mRS score 6).

Results

Included in the study were 12 patients (mean age 66±17 years, range 31–88 years; mean baseline National Institutes of Health stroke scale score 17±3, range 12–23). The occlusion sites were: internal carotid artery (ICA) terminus (five patients, including two concomitant cervical ICA occlusions), M1 segment (two patients), and basilar artery (two patients). Pharmacological treatment included intravenous (IV) t-PA only (two patients), IA urokinase only (nine patients), both IV t-PA and IA urokinase (one patient), and IV and/or IA eptifibatide (eight patients). Mean time to treatment was 5.9±3.9 h (anterior circulation) and 11.0±7.2 h (posterior circulation). Overall recanalization rate (TICI grade 2/3) was 91.6%. Procedure-related morbidity occurred in one patient (distal posterior inferior cerebellar artery embolus). There were no symptomatic hemorrhages. Outcomes at 90 days were independent (five patients), dependent (three patients) and dead (four patients, all due to progression of stroke with withdrawal of care).

Conclusion

Angioplasty of acutely occluded intracranial arteries with low-pressure elastomer balloons results in high recanalization rates with an acceptable degree of safety. Prior use of thrombolytics may increase the chances of recanalization, and glycoprotein IIb-IIIa inhibitors may be helpful in preventing reocclusion and in increasing patency rates.
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Metadata
Title
Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions
Authors
Raul G. Nogueira
Lee H. Schwamm
Ferdinando S. Buonanno
Walter J. Koroshetz
Albert J. Yoo
James D. Rabinov
Johnny C. Pryor
Joshua A. Hirsch
Publication date
01-04-2008
Publisher
Springer-Verlag
Published in
Neuroradiology / Issue 4/2008
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-007-0340-z

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