Outcomes After Intracranial Rescue Stenting for Acute Ischemic Stroke
Background In cases of failed recanalization despite modern mechanical thrombectomy (MT) techniques, intracranial rescue stenting (RS) may be beneficial. However, outcomes and complications of RS relative to the natural history of ongoing emergent large vessel occlusion are unknown. To evaluate whet...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-07-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.121.000129 |
| _version_ | 1797369977450266624 |
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| author | Christine Tschoe Stephanie Coffman Carol Kittel Patrick Brown Sami Al Kasab Eyad Almallouhi Alejandro Spiotta Brian Howard Ali Alawieh Adam Arthur Nitin Goyal Peter Kan Joon‐Tae Kim Reade De Leacy Ansaar Rai Min Park Robert Starke Pascal Jabbour Roberto Crosa Travis Dumont Ilko Maier Joshua Osbun Kyle Fargen Stacey Wolfe |
| author_facet | Christine Tschoe Stephanie Coffman Carol Kittel Patrick Brown Sami Al Kasab Eyad Almallouhi Alejandro Spiotta Brian Howard Ali Alawieh Adam Arthur Nitin Goyal Peter Kan Joon‐Tae Kim Reade De Leacy Ansaar Rai Min Park Robert Starke Pascal Jabbour Roberto Crosa Travis Dumont Ilko Maier Joshua Osbun Kyle Fargen Stacey Wolfe |
| author_sort | Christine Tschoe |
| collection | DOAJ |
| description | Background In cases of failed recanalization despite modern mechanical thrombectomy (MT) techniques, intracranial rescue stenting (RS) may be beneficial. However, outcomes and complications of RS relative to the natural history of ongoing emergent large vessel occlusion are unknown. To evaluate whether RS for ongoing emergent large vessel occlusion after failed MT achieves superior outcomes to the natural history of persistent emergent large vessel occlusion. Methods Patients from the Stroke Thrombectomy and Aneurysm Registry who underwent RS after failed MT from 2014 to 2019 were analyzed. For outcome comparisons, patients were screened for inclusion/exclusion criteria of 3 major randomized, controlled MT trials. Results Over 5 years, 2827 patients underwent thrombectomy, of which 120 required RS for failed revascularization. RS resulted in reperfusion (Thrombolysis in Cerebral Infarction≥2B) in 85.8%. Good 90‐day clinical outcomes (modified Rankin scale 0–2) were achieved in 33.9% of patients. Inclusion/exclusion criteria was met in 50 patients for MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), 64 patients for ESCAPE (Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke), and 45 patients for DAWN (DWI or CTP Assessment With Clinical Mismatch in the Triage of Wake‐Up and Late Presenting Strokes Undergoing Neurointervention). Of patients meeting trial criteria, 40.8% of the RS cohort achieved modified Rankin scale 0–2 versus 19% in the MR CLEAN medical arm (P<0.001) and 27% versus 13% in the RS versus DAWN medical arm (P=0.04). There was no difference in RS versus the ESCAPE medical arm (P=0.15). Symptomatic intracranial hemorrhage was not significantly increased after RS compared with MR CLEAN (P=0.06), but was increased compared with DAWN. Conclusion This large retrospective registry of RS for failed MT suggests that RS in trial‐eligible patients yields significantly improved outcomes over failed revascularization, with no significant increase in hemorrhagic events in early thrombectomy windows and comparable outcomes to successful thrombectomy at early and intermediate timeframes. |
| first_indexed | 2024-03-08T17:54:45Z |
| format | Article |
| id | doaj.art-e4c11c420a8845be9f97026f9ad114ad |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-03-08T17:54:45Z |
| publishDate | 2022-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-e4c11c420a8845be9f97026f9ad114ad2024-01-02T05:42:10ZengWileyStroke: Vascular and Interventional Neurology2694-57462022-07-012410.1161/SVIN.121.000129Outcomes After Intracranial Rescue Stenting for Acute Ischemic StrokeChristine Tschoe0Stephanie Coffman1Carol Kittel2Patrick Brown3Sami Al Kasab4Eyad Almallouhi5Alejandro Spiotta6Brian Howard7Ali Alawieh8Adam Arthur9Nitin Goyal10Peter Kan11Joon‐Tae Kim12Reade De Leacy13Ansaar Rai14Min Park15Robert Starke16Pascal Jabbour17Roberto Crosa18Travis Dumont19Ilko Maier20Joshua Osbun21Kyle Fargen22Stacey Wolfe23Baylor College of Medicine Houston TXWake Forest University School of Medicine Winston‐Salem NCWake Forest University School of Medicine Winston‐Salem NCWake Forest University School of Medicine Winston‐Salem NCMedical University of South Carolina Charleston SCMedical University of South Carolina Charleston SCMedical University of South Carolina Charleston SCEmory University Atlanta GAEmory University Atlanta GAUniversity of Tennessee Health Sciences Center Knoxville TNUniversity of Tennessee Health Science Center Memphis TNUniversity of Texas Medical Branch Galveston TXChonnam National University Hospital Gwangju South KoreaIcahn School of Medicine at Mount Sinai New York NYWest Virginia University Morgantown WVUniversity of Virginia Charlottesville VAUniversity of Miami Coral Gables FLThomas Jefferson University Woodbury NJMedica Uruguaya Stockholm SwedenUniversity of Arizona Tucson AZUniversity Medicine Göttingen Göttingen GermanyWashington University in St. Louis School of Medicine St. Louis MOWake Forest University School of Medicine Winston‐Salem NCWake Forest University School of Medicine Winston‐Salem NCBackground In cases of failed recanalization despite modern mechanical thrombectomy (MT) techniques, intracranial rescue stenting (RS) may be beneficial. However, outcomes and complications of RS relative to the natural history of ongoing emergent large vessel occlusion are unknown. To evaluate whether RS for ongoing emergent large vessel occlusion after failed MT achieves superior outcomes to the natural history of persistent emergent large vessel occlusion. Methods Patients from the Stroke Thrombectomy and Aneurysm Registry who underwent RS after failed MT from 2014 to 2019 were analyzed. For outcome comparisons, patients were screened for inclusion/exclusion criteria of 3 major randomized, controlled MT trials. Results Over 5 years, 2827 patients underwent thrombectomy, of which 120 required RS for failed revascularization. RS resulted in reperfusion (Thrombolysis in Cerebral Infarction≥2B) in 85.8%. Good 90‐day clinical outcomes (modified Rankin scale 0–2) were achieved in 33.9% of patients. Inclusion/exclusion criteria was met in 50 patients for MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), 64 patients for ESCAPE (Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke), and 45 patients for DAWN (DWI or CTP Assessment With Clinical Mismatch in the Triage of Wake‐Up and Late Presenting Strokes Undergoing Neurointervention). Of patients meeting trial criteria, 40.8% of the RS cohort achieved modified Rankin scale 0–2 versus 19% in the MR CLEAN medical arm (P<0.001) and 27% versus 13% in the RS versus DAWN medical arm (P=0.04). There was no difference in RS versus the ESCAPE medical arm (P=0.15). Symptomatic intracranial hemorrhage was not significantly increased after RS compared with MR CLEAN (P=0.06), but was increased compared with DAWN. Conclusion This large retrospective registry of RS for failed MT suggests that RS in trial‐eligible patients yields significantly improved outcomes over failed revascularization, with no significant increase in hemorrhagic events in early thrombectomy windows and comparable outcomes to successful thrombectomy at early and intermediate timeframes.https://www.ahajournals.org/doi/10.1161/SVIN.121.000129acute ischemic strokeemergent large vessel occlusionendovascular therapyintracranial stentingmechanical thrombectomyrescue stenting |
| spellingShingle | Christine Tschoe Stephanie Coffman Carol Kittel Patrick Brown Sami Al Kasab Eyad Almallouhi Alejandro Spiotta Brian Howard Ali Alawieh Adam Arthur Nitin Goyal Peter Kan Joon‐Tae Kim Reade De Leacy Ansaar Rai Min Park Robert Starke Pascal Jabbour Roberto Crosa Travis Dumont Ilko Maier Joshua Osbun Kyle Fargen Stacey Wolfe Outcomes After Intracranial Rescue Stenting for Acute Ischemic Stroke Stroke: Vascular and Interventional Neurology acute ischemic stroke emergent large vessel occlusion endovascular therapy intracranial stenting mechanical thrombectomy rescue stenting |
| title | Outcomes After Intracranial Rescue Stenting for Acute Ischemic Stroke |
| title_full | Outcomes After Intracranial Rescue Stenting for Acute Ischemic Stroke |
| title_fullStr | Outcomes After Intracranial Rescue Stenting for Acute Ischemic Stroke |
| title_full_unstemmed | Outcomes After Intracranial Rescue Stenting for Acute Ischemic Stroke |
| title_short | Outcomes After Intracranial Rescue Stenting for Acute Ischemic Stroke |
| title_sort | outcomes after intracranial rescue stenting for acute ischemic stroke |
| topic | acute ischemic stroke emergent large vessel occlusion endovascular therapy intracranial stenting mechanical thrombectomy rescue stenting |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.121.000129 |
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