Feasibility of emergent single-step intracranial self-expanding stent deployment using over-the-wire coronary balloons in intracranial atherosclerosis-related large vessel occlusion thrombectomy

Alhamza R Al-Bayati; Mohamed F Doheim; Mahmoud H Mohammaden; Michael Lang; Bradley Gross; Diogo C Haussen; Raul G Nogueira

doi:10.1136/jnis-2025-023074

Feasibility of emergent single-step intracranial self-expanding stent deployment using over-the-wire coronary balloons in intracranial atherosclerosis-related large vessel occlusion thrombectomy

J Neurointerv Surg. 2025 May 8:jnis-2025-023074. doi: 10.1136/jnis-2025-023074. Online ahead of print.

Authors

Alhamza R Al-Bayati^{1

2}, Mohamed F Doheim^{1

2}, Mahmoud H Mohammaden³, Michael Lang², Bradley Gross², Diogo C Haussen^{3

4}, Raul G Nogueira^{5

2}

Affiliations

¹ Neurology, UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
² Neurosurgery, UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
³ Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
⁴ Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
⁵ Neurology, UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA raul.g.nogueira@icloud.com.

PMID: 40345799
DOI: 10.1136/jnis-2025-023074

Abstract

Background: The currently US Food and Drug Administration approved intracranial stent delivery system involves a multistep deployment process that requires the use of an exchange length microwire (ELW). In this study, we describe a single-step approach to deploy the Neuroform Atlas stent without the need for ELW or lesion re-access, using the MINI TREK II over-the-wire (OTW) semi-compliant coronary balloon.

Methods: We performed a retrospective review of prospectively maintained mechanical thrombectomy databases from two comprehensive stroke centers. The study included consecutive large vessel occlusion (LVO) stroke patients who underwent single-step angioplasty with the MINI TREK II OTW balloon followed by deployment of the Neuroform Atlas intracranial stent, without the use of an ELW.

Results: A total of 12 patients met the inclusion criteria. Among them, the median age was 67 years (IQR: 58-73) and 50% were female. Most patients had middle cerebral artery (MCA) M1 occlusion (75%). One-third of the patients received intravenous thrombolysis. All patients achieved successful reperfusion (modified Treatment in Cerebral Ischemia (mTICI) 2b/3) with a median of two passes. The median National Institutes of Health Stroke Scale (NIHSS) score decreased from 14 (IQR: 10-19) at baseline to 4 (IQR: 1-9) at discharge, and the median modified Rankin Scale (mRS) score was 1 (IQR: 1-4) at discharge and 3 (IQR: 2-4) at 90 days. None of the patients in this series experienced symptomatic intracranial hemorrhage, though two patients (16.7%) were dead at 90 days but there was no procedural-related mortality.

Conclusions: This preliminary experience demonstrates the technical feasibility and success of single-step deployment of the Neuroform Atlas stent following angioplasty with the MINI TREK II OTW balloon, without the need for an ELW or lesion re-access. Larger prospective studies with extended clinical follow-up are needed to validate these findings.

Keywords: Angioplasty; Atherosclerosis; Balloon; Thrombectomy.