Primary results of treatment of hyper acute ischemia by thrombus retrieve with Solitaire devices associated with intra-arterial fibrolytic with rtPA: Report of 2 cases

Dr Vu Dang Luu1, Dr Tran Anh Tuan1, Dr Le Hoang Kien1, Dr Nguyen Quang Anh1, Dr Nguyen Duy Trinh1, professor Pham Minh Thong1, Dr Mai Duy Ton2, Dr Nguyen Dat Anh2
1 Imaging dept Bach Mai Hospital
2 Hospital Emergency Department Bach Mai

Main Article Content

Abstract

Brain ischemia accounts for 85% of brain stroke and this is 3rd leading cause of mortality or mobility in the world. The treatment of hyper acute ischemia by intravenous infusion of fibrolytic (rtPA) has been recently progressive. However, this indication is only selected for the patient coming early during first 3 hours after onset and it also gets some limitations in cases of main artery occlusion. The super selective endovascular treatment of brain ischemia by using thrombus retrieve device (solitaire) associated with fibrolytic (rtPA) has been confirmed to be increased the rate of recanalization and good outcome recently. We want to report our 2 cases of treatment of hyper acute ischemia by clot retrieve with Solitaire devices and fibrolytic with rtPA and review the literature. 

Article Details

References

1. Del Zoppo GJ, Poeck K, Pessin MS et al. Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. Ann Neurol., 1992 Jul; 32(1):78-86.
2. Dorn F, Stehle S, Lockau H, et al, Endovascular Treatment of Acute Intracerebral Artery Occlusions with the Solitaire Stent: Single-Centre Experience with 108 Recanalization Procedures. Cerebrovasc Dis. 2012 Jun 30; 34(1):70-77.
3. Koh JS, Lee SJ, Ryu CW, Kim HS, Safety and efficacy of mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke: a systematic review. Neurointervention. 2012 Feb;7(1):1-9. Epub 2012.
4. Shi ZS, Loh Y, Walker G, et al., Clinical outcomes in middle cerebral artery trunk occlusions versus secondary division occlusions after mechanical
thrombectomy: pooled analysis of the mechanical embolus removal in cerebral ischemia (MERCI) and 5. Smith WS, Sung G, et al., Mechanical
thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 2008; 39:1205-1212.
6. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group, Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995 Dec 14; 333(24):1581-7.
7. The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 2009; 40:2761-2768.