Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2023; 11(21): 5047-5055
Published online Jul 26, 2023. 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
Qing-Yang Yao, Mao-Lin Fu, Qing Zhao, Xiao-Ming Zheng, Kai Tang, Li-Ming Cao
Qing-Yang Yao, Department of Neurology, The First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
Mao-Lin Fu, Qing Zhao, Xiao-Ming Zheng, Kai Tang, Department of Neurology, The 910th Hospital of the Joint Logistics Support Force of the Chinese PLA, Quanzhou 362000, Fujian Province, China
Li-Ming Cao, Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen 518000, Guangdong Province, China
Li-Ming Cao, Hunan Provincial Key Laboratory of The Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha 410219, Hunan Province, China
Author contributions: Cao LM drafted the manuscript and conceived the study; Yao QY and Fu ML provided resources and constructive discussion; Zhao Q, Zheng XM, and Tang K analyzed the imaging and provided constructive discussion; Yao QY and Fu ML contributed equally to this work; all authors have read and approved the final manuscript.
Supported by The Clinical Research Project of The First Affiliated Hospital of Shenzhen University, No. 20223357030 and No. 20223357021, and the “Double-First Class” Application Characteristic Discipline of Hunan Province (Pharmaceutical Science).
Institutional review board statement: The study design was approved by the ethics review board of the 910th Hospital of the Joint Logistics Support Force of the Chinese PLA (No. 2021-29).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Not applicable.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Ming Cao, MD, PhD, Adjunct Associate Professor, Hunan Provincial Key Laboratory of The Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, No. 1501 Leifeng Avenue, Wangcheng District, Changsha 410219, China. caolm-2007@163.com
Received: April 10, 2023
Peer-review started: April 10, 2023
First decision: May 8, 2023
Revised: May 17, 2023
Accepted: July 4, 2023
Article in press: July 4, 2023
Published online: July 26, 2023
Processing time: 107 Days and 9.8 Hours
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: Digital subtraction angiography; Solitaire AB stent; Acute ischemic stroke; Stent-based mechanical thrombectomy; Visualization of stents

Core Tip: We present the case report of four patients with acute ischemic stroke (AIS) who underwent stent-based mechanical thrombectomy. In this study, we were able to visualize the developing stent, including the capture of the thrombi during mechanical thrombectomy. This study has demonstrated that visualizing stents using imaging is suitable for assessing stent deployment and procedural optimization during stent-based mechanical thrombectomy. To the best of our knowledge, this is the first report of stent imaging in patients with AIS undergoing stent-based mechanical thrombectomy. This study contributes significantly to the literature by evaluating the usefulness and enormous potential of stent imaging in stent-based mechanical thrombectomy for AIS.