Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2021; 9(19): 5028-5036
Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5028
Efficacy of Solitaire AB stent-release angioplasty in acute middle cerebral artery atherosclerosis obliterative cerebral infarction
Xi-Feng Wang, Ming Wang, Gang Li, Xue-Yu Xu, Wei Shen, Jing Liu, Shuang-Shuang Xiao, Jiang-Hong Zhou
Xi-Feng Wang, Ming Wang, Gang Li, Xue-Yu Xu, Wei Shen, Jing Liu, Shuang-Shuang Xiao, Jiang-Hong Zhou, Department of Neurology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, Hubei Province, China
Author contributions: Wang XF, Wang M and Li G designed the research; Xu XY, Shen W and Liu J performed the research; Liu J and Xiao SS contributed new reagents/analytic tools; Wang XF analyzed the data; Wang XF and Zhou JH wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology Institutional Review Board.
Informed consent statement: Informed written consent was obtained from the patients.
Conflict-of-interest statement: No one at any time received payment or services from a third party (government, commercial, private foundation, etc.) for any aspect of the submitted work (including but not limited to grants, data monitoring board, study design, manuscript preparation, statistical analysis). No one has financial relationships (regardless of amount of compensation) with entities as described in the instructions during the 36 mo prior to publication.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at 815107426@qq.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jiang-Hong Zhou, MSc, Professor, Department of Neurology, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 76 Jiefang Avenue, Qiaokou District, Wuhan 430033, Hubei Province, China. 815107426@qq.com
Received: March 2, 2021
Peer-review started: March 2, 2021
First decision: April 4, 2021
Revised: April 10, 2021
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: July 6, 2021
Processing time: 113 Days and 22.5 Hours
Abstract
BACKGROUND

In both national and international studies, the safety and effectiveness of treatment with the Solitaire stent in patients with ischemic stroke caused by acute large vessel occlusion were good, and the disability rate was significantly reduced. However, there are currently only a few reports on the differences in endovascular treatment for different etiological classifications, especially in the anterior cranial circulation, aorta atherosclerotic stenosis, and acute thrombosis.

AIM

To investigate the efficacy of Solitaire AB stent-release angioplasty in patients with acute middle cerebral artery atherosclerosis obliterative cerebral infarction.

METHODS

Twenty-five patients with acute middle cerebral atherosclerosis obliterative cerebral infarction were retrospectively enrolled in this study from January 2017 to December 2019. The Solitaire AB stent was used to improve anterior blood flow to maintain modified cerebral infarction thrombolysis [modified thrombolysis in cerebral infarction (mTICI)] at the 2b/3 level or above, the stent was then unfolded and released.

RESULTS

All 25 patients underwent successful surgery, with an average recanalization time of 23 min. One patient died of cerebral hemorrhage and cerebral herniation after the operation. The National Institutes of Health Stroke Scale (NIHSS) scores immediately after surgery (7.5 ± 5.6), at 24 h (5.5 ± 5.6) and at 1 wk (3.6 ± 6.7) compared with the preoperative NIHSS score (15.9 ± 4.4), were significantly different (P < 0.01). One case of restenosis was observed 3 mo after surgery (the stenosis rate was 50% without clinical symptoms), the modified Rankin scale scores were 0 points in 14 cases (56%), 1 point in 4 cases (16%), 2 points in 2 cases (8%), 3 points in 3 cases (12%), 4 points in 1 case (4%), and 6 points in 1 case (4%).

CONCLUSION

In acute middle cerebral artery atherosclerosis obliterative cerebral infarction, when the Solitaire AB stent is unfolded and the forward blood flow is maintained at mTICI level 2b/3 or higher, stent release may be a safe and effective treatment method; however, long-term observation and a larger sample size are required to verify these findings.

Keywords: Stent angioplasty; Atherosclerosis obliterative; Acute cerebral infarction

Core Tip: There are currently only a few reports on the differences in endovascular treatment for different etiological classifications, especially in the anterior cranial circulation, aorta atherosclerotic stenosis, and acute thrombosis. There are no relevant reports on the use of Solitaire stent mechanical thrombectomy or stent release angioplasty when used above level 2b/3 (modified thrombolysis in cerebral infarction).