Report and literature review of the Solitaire stent retriever in treatment of acute posterior circulation ischemia

Objective To explor the safety and effectiveness of intraveneous thrombolysis bridged endovascular thrombectomy with the Solitaire stent retriever for acute posterior circulation ischemia. Methods Three patients undergoing bridged endovascular thrombectomy after acute basilar artery thrombosis in the Liaocheng People′s Hospital from August to September 2017 were analyzed retrospectively. The obstructed arteries were basal artery. The primary outcomes included reperfusion immediately, complications and neurologic improvement. Secondary outcomes were the functional scores on the modified Rankin scale (mRS) and Barther index (BI) after 90 days. Results The basilar artery thrombosis of the 3 patients were revascularized after intraveneous thrombolysis bridged endovascular thrombectomy. The first patient′s condition improved at one time, then aggravated again after four hours presenting with coma and vascular occlusion, after mechanical thrombectomy in emergency, the patient was conscious in the next morning. The other two patients underwent intravenous thrombolysis and mechanical thrombectomy simultaneously. Three paients were reexamined by brain CT and CT angiography 5 to 7 days after procedure. There were no significant expansion of cerebral infarction and symptomatic intracranial hemorrhage(SICH). The NIHSS scores were 16-27 points lower than those at admission in 3 patients. The mRS scores in 3 patients were 3(1 patient), 2(2 patients) point at discharge. Three months after discharge, the mRS scores were 2 (1 patients), 1(2 patients) point, and the barher index(BI)scores were 95-100 points. Conclusions Intravenous thrombolysis bridged early thrombectomy with the Solitaire stent retriever improve revascularization, early neurologic recovery, and functional outcome. Key words: Intraveneous thrombolysis; Solitaire stent; Posterior circulation ischemia; Basilar aitery