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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(05): 332-338
DOI: 10.1590/0004-282X20180027
Article

Rescue therapy with stent retrievers for thromboembolism during endovascular treatment of intracranial aneurysms

Terapia de resgate com stent para tromboembolismo durante tratamento endovascular de aneurismas intracranianos
Zeferino Demartini Junior
1   Pontifícia Universidade Católica do Paraná, Departamento de Neurocirurgia, Curitiba PR, Brasil;
,
Luana A. Maranha Gatto
1   Pontifícia Universidade Católica do Paraná, Departamento de Neurocirurgia, Curitiba PR, Brasil;
,
Gelson Luis Koppe
1   Pontifícia Universidade Católica do Paraná, Departamento de Neurocirurgia, Curitiba PR, Brasil;
,
Tatiana F. von Hertwig de Oliveira
1   Pontifícia Universidade Católica do Paraná, Departamento de Neurocirurgia, Curitiba PR, Brasil;
,
Alexandre Novicki Francisco
1   Pontifícia Universidade Católica do Paraná, Departamento de Neurocirurgia, Curitiba PR, Brasil;
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ABSTRACT

Thromboembolism is the most frequent complication in endovascular treatment of intracranial aneurysms, causing disability and death. As stent retrievers have achieved high rates of arterial recanalization in the management of ischemic stroke, these devices were tested as rescue therapy of thromboembolism during aneurysm embolization. We retrospectively analyzed 10 consecutive patients with transprocedural arterial occlusion, treated with mechanical thrombectomy at a single center. Good angiographic recanalization was achieved in eight cases, mTICI 3, 2b and 2a in five, three and two patients, respectively, without additional complications or any deaths. Five patients showed complete recovery (mRS 0) and all patients showed improvement of disability (average mRS 1.1) over a mean follow-up period of 31 months. Eight patients had good clinical recovery, while two remained with deficits (mRS 3 and 4). The study found that the stent retriever is a valuable, rapid and effective tool for restoring blood flow, improving the safety of endovascular treatment.

RESUMO

Tromboembolismo é a complicação mais frequente no tratamento endovascular de aneurismas cerebrais, podendo causar morte ou sequelas. Como os stent retrievers alcançaram altas taxas de recanalização arterial no tratamento do acidente vascular encefálico isquêmico, testamos esses dispositivos para tratar eventos tromboembólicos ocorridos durante a embolização de aneurismas. Foram analisados retrospectivamente 10 pacientes apresentando oclusão arterial transoperatória, tratados com trombectomia mecânica em um único centro. Obtivemos recanalização angiográfica em oito casos, mTICI 3, 2b e 2a em cinco, três e dois pacientes, respectivamente, sem complicações adicionais ou óbito. Cinco casos apresentaram recuperação completa (mRS 0) e todos os pacientes apresentaram melhora dos déficits (mRS médio 1.1) durante acompanhamento médio de 31 meses. Oito pacientes apresentaram boa recuperação clínica, enquanto dois permaneceram com déficits (mRS 3 e 4). O estudo concluiu que stents são uma ferramenta valiosa, rápida e eficaz para restaurar o fluxo sanguíneo, aumentando a segurança do tratamento endovascular.

Keywords:

intracranial aneurysms - intraoperative complications - thromboembolism - endovascular procedure - stent

Palavras-chave:

aneurisma intracraniano - complicações intraoperatórias - tromboembolia - procedimentos endovasculares - stents


Publikationsverlauf

Eingereicht: 29. Oktober 2017

Angenommen: 24. Januar 2018

Artikel online veröffentlicht:
25. August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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