Emergency intracranial stenting in acute stroke: Predictors for poor outcome and for complications

Christian Paul Stracke, Jens Fiehler, Lukas Meyer, Gotz Thomalla, Lars Udo Krause, Stephan Lowens, Jan Rothaupt, Byungmoon Kim, Ji Hoe Heo, Leonard L.L. Yeo, Tommy Andersson, Christoph Kabbasch, Franziska Dorn, Rene Chapot, Uta Hanning

Research output: Contribution to journalArticlepeer-review

Abstract

Background-—Stent-retriever thrombectomy is the first-line therapy in acute stroke with intracranial large vessel occlusion. In case of failure of stent-retriever thrombectomy, rescue stent angioplasty might be the only treatment option to achieve permanent recanalization. This study aims at identifying predictors for poor outcome and complications in a large, multicenter cohort receiving rescue stent angioplasty. Methods and Results-—We performed a retrospective analysis of patients with large vessel occlusion who were treated with rescue stent angioplasty after stent-retriever thrombectomy between 2012 and 2018 in 7 neurovascular centers. We defined 2 binary outcomes: (1) functional clinical outcome (good modified Rankin Scale, 0–2; and poor modified Rankin Scale, 4–6) and (2) early symptomatic intracerebral hemorrhage. Impacts of clinical, radiological, and interventional parameters on outcomewere assessed in uni-and multivariable logistic regression models. Two hundred ten patients were included with target vessels located within the anterior circulation (136 of 210; 64.8%) and posterior circulation (74 of 210; 35.2%). Symptomatic intracerebral hemorrhage occured in 22 patients, 86.4% (19 of 22) after anterior and 13.6% (3 of 22) after posterior circulation large vessel occlusion. Good functional outcome was observed in 44.8% (73 of 163). A higher National Institutes of Health Stroke Scale on admission (adjusted odds ratio, 1.10; P=0.002), a higher premorbid modified Rankin Scale (adjusted odds ratio, 2.02; P=0.049), and a modified Thrombolysis in Cerebral Infarction score of 0 to 2a after stenting (adjusted odds ratio, 23.24; P<0.001) were independent predictors of poor functional outcome. Conclusions-—Use of rescue stent angioplasty can be considered for acute intracranial large vessel occlusion in cases after unsuccessful stent-retriever thrombectomy. Likelihood of symptomatic intracerebral hemorrhage is higher in anterior circulation stroke.

Original languageEnglish
Article numbere012795
JournalJournal of the American Heart Association
Volume9
Issue number5
DOIs
Publication statusPublished - 2020

Bibliographical note

Funding Information:
Disclosures Stracke is a consultant and/or proctor for Acandis, Balt, and Rapid Medical. Fiehler received research support from German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions-und Forderbank (IFB), Medtronic, Microvention, Philips, and Stryker and is a consultant for Acandis, Boehringer Ingelheim, Cerenovus, Covidien, Evasc Neurovascular, MD Clinicals, Medtronic, Medina, Microvention, Penumbra, Route92, Stryker, and Transverse Medical. Gotz Thomalla received consulting fees from Acandis, grant support and lecture fees from Bayer, lecture fees from Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, and Daiichi Sankyo, and consulting fees and lecture fees from Stryker. Krause received speaker honoraria from Boehringer Ingelheim, Medtronic, and Stryker. Rothaupt is a consultant for Acandis and Phenox. Andersson is a consultant for Ablynx, Amnis Therapeutics, Medtronic, Cerenovus/J&J, Rapid Medical, and Anaconda. Yeo has received substantial grant funding from the National Medical Research Council (NMRC), Singapore and substantial support from the ministry of health (MOH), Singapore. Christoph Kabbasch is a proctor for Acandis. Dorn is a consultant for Acandis. Rene Chapot is a consultant and/or proctor for BALT, Stryker, Microvention, Rapid Medical, and Siemens Medical Systems. The remaining authors have no disclosures to report.

Funding Information:
Stracke is a consultant and/or proctor for Acandis, Balt, and Rapid Medical. Fiehler received research support from German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hambur-gische Investitions-und Forderbank (IFB), Medtronic, Microvention, Philips, and Stryker and is a consultant for Acandis, Boehringer Ingelheim, Cerenovus, Covidien, Evasc Neurovascular, MD Clinicals, Medtronic, Medina, Microven-tion, Penumbra, Route92, Stryker, and Transverse Medical. Gotz Thomalla received consulting fees from Acandis, grant support and lecture fees from Bayer, lecture fees from Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, and Dai-ichi Sankyo, and consulting fees and lecture fees from Stryker. Krause received speaker honoraria from Boehringer Ingelheim, Medtronic, and Stryker. Rothaupt is a consultant for Acandis and Phenox. Andersson is a consultant for Ablynx, Amnis Therapeutics, Medtronic, Cerenovus/J&J, Rapid Medical, and Anaconda. Yeo has received substantial grant funding from the National Medical Research Council (NMRC), Singapore and substantial support from the ministry of health (MOH), Singapore. Christoph Kabbasch is a proctor for Acandis. Dorn is a consultant for Acandis. Rene Chapot is a consultant and/or proctor for BALT, Stryker, Microvention, Rapid Medical, and Siemens Medical Systems. The remaining authors have no disclosures to report.

Publisher Copyright:
© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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