Rescue stenting for failed mechanical thrombectomy in acute ischemic stroke a multicenter experience

Yoonkyung Chang, Byung Moon Kim, Oh Young Bang, Jang Hyun Baek, Ji Hoe Heo, Hyo Suk Nam, Young Dae Kim, Joonsang Yoo, Dong Joon Kim, Pyoung Jeon, Seung Kug Baik, Sang Hyun Suh, Kyung Yul Lee, Hyo Sung Kwak, Hong Gee Roh, Young Jun Lee, Sang Heum Kim, Chang Woo Ryu, Yon Kwon Ihn, Byungjun KimHong Jun Jeon, Jin Woo Kim, Jun Soo Byun, Sangil Suh, Jeong Jin Park, Woong Jae Lee, Jieun Roh, Byoung Soo Shin, Jeong Min Kim

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Abstract

Background and Purpose-Effective rescue treatment has not yet been suggested in patients with mechanical thrombectomy (MT) failure. This study aimed to test whether rescue stenting (RS) improved clinical outcomes in MT-failed patients. Methods-This is a retrospective analysis of the cohorts of the 16 comprehensive stroke centers between September 2010 and December 2015. We identifed the patients who underwent MT but failed to recanalize intracranial internal carotid artery or middle cerebral artery M1 occlusion. Patients were dichotomized into 2 groups: patients with RS and without RS after MT failure. Clinical and laboratory fndings and outcomes were compared between the 2 groups. It was tested whether RS is associated with functional outcome. Results-MT failed in 148 (25.0%) of the 591 patients with internal carotid artery or middle cerebral artery M1 occlusion. Of these 148 patients, 48 received RS (RS group) and 100 were left without further treatment (no stenting group). Recanalization was successful in 64.6% (31 of 48 patients) of RS group. Compared with no stenting group, RS group showed a signifcantly higher rate of good outcome (modifed Rankin Scale score, 0-2; 39.6% versus 22.0%; P=0.031) without increasing symptomatic intracranial hemorrhage (16.7% versus 20.0%; P=0.823) or mortality (12.5% versus 19.0%; P=0.360). Of the RS group, patients who had recanalization success had 54.8% of good outcome, which is comparable to that (55.4%) of recanalization success group with MT. RS remained independently associated with good outcome after adjustment of other factors (odds ratio, 3.393; 95% confdence interval, 1.192-9.655; P=0.022). Follow-up vascular imaging was available in the 23 (74.2%) of 31 patients with recanalization success with RS. The stent was patent in 20 (87.0%) of the 23 patients. Glycoprotein IIb/IIIa inhibitor was signifcantly associated with stent patency but not with symptomatic intracranial hemorrhage. Conclusions-RS was independently associated with good outcomes without increasing symptomatic intracranial hemorrhage or mortality. RS seemed considered in MT-failed internal carotid artery or middle cerebral artery M1 occlusion.

Original languageEnglish
Pages (from-to)958-964
Number of pages7
JournalStroke
Volume49
Issue number4
DOIs
Publication statusPublished - 2018 Apr

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All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Chang, Y., Kim, B. M., Bang, O. Y., Baek, J. H., Heo, J. H., Nam, H. S., Kim, Y. D., Yoo, J., Kim, D. J., Jeon, P., Baik, S. K., Suh, S. H., Lee, K. Y., Kwak, H. S., Roh, H. G., Lee, Y. J., Kim, S. H., Ryu, C. W., Ihn, Y. K., ... Kim, J. M. (2018). Rescue stenting for failed mechanical thrombectomy in acute ischemic stroke a multicenter experience. Stroke, 49(4), 958-964. https://doi.org/10.1161/STROKEAHA.117.020072