Treatment of acute cerebral artery occlusion with a fully recoverable intracranial stent: a new technique.

A 42-year-old woman was referred to our institution with sudden onset of ataxia, facial paresis, horizontal gaze palsy, and progressive dysarthria. The patient worsened within a few minutes, with appearance of left hemiparesis. The National Institutes of Health Stroke Scale Score was 13. On computer tomography scan 2 hours after stroke onset, no brain stem lesion or intracranial bleeding was visible. Computed tomographic angiography revealed a mid basilar vessel occlusion, which suggested embolic basilar artery occlusion. A 4-vessel angiogram with a 5F diagnostic catheter confirmed the basilar artery occlusion and depicted more precisely the location of the thrombus (Figure 1A). To treat the patient, a 6F guiding catheter was inserted into the right vertebral artery. A 0.021-inch Rebar 27 microcatheter (ev3, Irvine, Calif) coaxially loaded over a 0.14-inch Silverspeed microwire (ev3, Irvine, Calif) was placed directly into the thrombus. Tissue plasminogen activator (40 mg/30 min) was administered intra-arterially. No recanalization was noticed on the control angiogram. After the unsuccessful intraarterial thrombolysis, we performed stent-assisted mechanical recanalization with the Solitaire FR revascularization device (ev3, Irvine, Calif). The Solitaire FR is a new self-expanding, fully retrievable nitinol stent based on the Solitaire AB that is commonly used for stent-assisted treatment of intracranial aneurysms. A Rebar 27 microcatheter was navigated past the thrombus into the left P1 segment. The stent was placed and deployed from the left P1 segment into the basilar artery, with the middle third of the device residing within the thrombus formation. The subsequent angiogram showed flow restoration of the basilar artery with a narrowing in the middle part of the vessel due to compression of the thrombus into the arterial wall (Figure 1B). To withdraw the thrombus, the unfolded Solitaire stent and the Rebar microcatheter were slowly pulled into the guide catheter with constant aspiration with a 50-mL syringe from the guide catheter. Withdrawal was possible with minor effort and was observed under