Revascularization of symptomatic subacute cerebrovascular occlusions with a self-expanding intracranial stent system

OBJECTIVE: In some patients, collateral circulation may preserve the viability of brain parenchyma distal to an intracranial arterial occlusion for hours or days after the presenting event. These patients may be good candidates for revascularization, even when they present outside of the accepted 6-hour time window for stroke intervention. METHODS: Three patients were revascularized with the Wingspan stent system (Boston Scientific/Target, Fremont, CA) after presenting with subacute occlusions of intracranial arteries and progressive ischemic symptoms despite maximal medical therapy. All pre- and postprocedural imaging data and clinical records were reviewed. RESULTS: Three patients (mean age, 64 years; 2 women, 1 man) presented with symptomatic intracranial occlusions of the internal carotid artery (n = 2) and vertebrobasilar system (n = 1). All 3 patients presented more than 6 hours after symptom onset, and no intravenous or intra-arterial thrombolysis had been instituted. In all cases, despite supportive medical therapy (anticoagulation and antiplatelet therapy and induced hypertension), the patients continued to demonstrate progressive ischemia, both clinically and on diffusion magnetic resonance imaging. All patients were successfully revascularized without periprocedural complications and improved clinically after revascularization. CONCLUSION: In selected patients, symptomatic subacute occlusions of intracranial arteries may be revascularized using the Wingspan stent system.