Stenting as a Rescue Treatment after Failure of Mechanical Thrombectomy for Anterior Circulation Large Artery Occlusion

Jang Hyun Baek, Byung Moon Kim, Dong Joon Kim, Ji Hoe Heo, Hyo Suk Nam, Joonsang Yoo

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background and Purpose - We hypothesized that permanent stenting may be a rescue treatment for stentriever-failed anterior circulation large artery occlusion. We compared the outcomes among patients with permanent stenting and those without stenting after stentriever failure. Methods - We retrospectively evaluated 208 patients who underwent stentriever thrombectomy for anterior circulation large artery occlusion between September 2010 and September 2015. Modified thrombolysis in cerebral ischemia 2b-3 recanalization was achieved with stentriever alone or in combination with Penumbra device in 155 patients (74.5%). An additional 8 patients (3.8%) obtained modified thrombolysis in cerebral ischemia 2b-3 with urokinase or glycoprotein IIb/IIIa inhibitor infusion. Of the remaining 45 patients (21.6%), 17 underwent stenting (stenting group; mean age, 68 years), whereas 28 did not undergo stenting (nonstenting group; mean age, 72 years). The rate of modified thrombolysis in cerebral ischemia 2b-3 in stenting group was assessed, and clinical outcomes were compared between groups. Results - There were no differences in clinical and laboratory findings, initial National Institute of Health Stroke Scale score, location of anterior circulation large artery occlusion, and onset-to-puncture time between groups. Modified thrombolysis in cerebral ischemia 2b-3 was achieved in 14 members (83.3%) of the stenting group. Stenting group had more favorable outcomes (modified Rankin Scale score 0-2, 35.3%) and less cerebral herniation (11.8%) than nonstenting group (modified Rankin Scale score 0-2, 7.1%; cerebral herniation, 42.9%; P<0.05 for both). Symptomatic intracranial hemorrhage and mortality rates did not differ between stenting group (symptomatic intracranial hemorrhage, 11.8%; mortality, 23.5%) and nonstenting group (symptomatic intracranial hemorrhage, 14.3%; mortality, 39.3%). Conclusions - Permanent stenting may be a rescue modality for stentriever-failed anterior circulation large artery occlusion. A large prospective study is necessary for confirmation because of the small sample size of this study.

Original languageEnglish
Pages (from-to)2360-2363
Number of pages4
JournalStroke
Volume47
Issue number9
DOIs
Publication statusPublished - 2016 Sep 1

Fingerprint

Thrombectomy
Treatment Failure
Brain Ischemia
Arteries
Intracranial Hemorrhages
Mortality
Platelet Glycoprotein GPIIb-IIIa Complex
Urokinase-Type Plasminogen Activator
National Institutes of Health (U.S.)
Punctures
Sample Size
Stroke
Prospective Studies
Equipment and Supplies

All Science Journal Classification (ASJC) codes

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

Cite this

Baek, Jang Hyun ; Kim, Byung Moon ; Kim, Dong Joon ; Heo, Ji Hoe ; Nam, Hyo Suk ; Yoo, Joonsang. / Stenting as a Rescue Treatment after Failure of Mechanical Thrombectomy for Anterior Circulation Large Artery Occlusion. In: Stroke. 2016 ; Vol. 47, No. 9. pp. 2360-2363.
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abstract = "Background and Purpose - We hypothesized that permanent stenting may be a rescue treatment for stentriever-failed anterior circulation large artery occlusion. We compared the outcomes among patients with permanent stenting and those without stenting after stentriever failure. Methods - We retrospectively evaluated 208 patients who underwent stentriever thrombectomy for anterior circulation large artery occlusion between September 2010 and September 2015. Modified thrombolysis in cerebral ischemia 2b-3 recanalization was achieved with stentriever alone or in combination with Penumbra device in 155 patients (74.5{\%}). An additional 8 patients (3.8{\%}) obtained modified thrombolysis in cerebral ischemia 2b-3 with urokinase or glycoprotein IIb/IIIa inhibitor infusion. Of the remaining 45 patients (21.6{\%}), 17 underwent stenting (stenting group; mean age, 68 years), whereas 28 did not undergo stenting (nonstenting group; mean age, 72 years). The rate of modified thrombolysis in cerebral ischemia 2b-3 in stenting group was assessed, and clinical outcomes were compared between groups. Results - There were no differences in clinical and laboratory findings, initial National Institute of Health Stroke Scale score, location of anterior circulation large artery occlusion, and onset-to-puncture time between groups. Modified thrombolysis in cerebral ischemia 2b-3 was achieved in 14 members (83.3{\%}) of the stenting group. Stenting group had more favorable outcomes (modified Rankin Scale score 0-2, 35.3{\%}) and less cerebral herniation (11.8{\%}) than nonstenting group (modified Rankin Scale score 0-2, 7.1{\%}; cerebral herniation, 42.9{\%}; P<0.05 for both). Symptomatic intracranial hemorrhage and mortality rates did not differ between stenting group (symptomatic intracranial hemorrhage, 11.8{\%}; mortality, 23.5{\%}) and nonstenting group (symptomatic intracranial hemorrhage, 14.3{\%}; mortality, 39.3{\%}). Conclusions - Permanent stenting may be a rescue modality for stentriever-failed anterior circulation large artery occlusion. A large prospective study is necessary for confirmation because of the small sample size of this study.",
author = "Baek, {Jang Hyun} and Kim, {Byung Moon} and Kim, {Dong Joon} and Heo, {Ji Hoe} and Nam, {Hyo Suk} and Joonsang Yoo",
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Stenting as a Rescue Treatment after Failure of Mechanical Thrombectomy for Anterior Circulation Large Artery Occlusion. / Baek, Jang Hyun; Kim, Byung Moon; Kim, Dong Joon; Heo, Ji Hoe; Nam, Hyo Suk; Yoo, Joonsang.

In: Stroke, Vol. 47, No. 9, 01.09.2016, p. 2360-2363.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stenting as a Rescue Treatment after Failure of Mechanical Thrombectomy for Anterior Circulation Large Artery Occlusion

AU - Baek, Jang Hyun

AU - Kim, Byung Moon

AU - Kim, Dong Joon

AU - Heo, Ji Hoe

AU - Nam, Hyo Suk

AU - Yoo, Joonsang

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background and Purpose - We hypothesized that permanent stenting may be a rescue treatment for stentriever-failed anterior circulation large artery occlusion. We compared the outcomes among patients with permanent stenting and those without stenting after stentriever failure. Methods - We retrospectively evaluated 208 patients who underwent stentriever thrombectomy for anterior circulation large artery occlusion between September 2010 and September 2015. Modified thrombolysis in cerebral ischemia 2b-3 recanalization was achieved with stentriever alone or in combination with Penumbra device in 155 patients (74.5%). An additional 8 patients (3.8%) obtained modified thrombolysis in cerebral ischemia 2b-3 with urokinase or glycoprotein IIb/IIIa inhibitor infusion. Of the remaining 45 patients (21.6%), 17 underwent stenting (stenting group; mean age, 68 years), whereas 28 did not undergo stenting (nonstenting group; mean age, 72 years). The rate of modified thrombolysis in cerebral ischemia 2b-3 in stenting group was assessed, and clinical outcomes were compared between groups. Results - There were no differences in clinical and laboratory findings, initial National Institute of Health Stroke Scale score, location of anterior circulation large artery occlusion, and onset-to-puncture time between groups. Modified thrombolysis in cerebral ischemia 2b-3 was achieved in 14 members (83.3%) of the stenting group. Stenting group had more favorable outcomes (modified Rankin Scale score 0-2, 35.3%) and less cerebral herniation (11.8%) than nonstenting group (modified Rankin Scale score 0-2, 7.1%; cerebral herniation, 42.9%; P<0.05 for both). Symptomatic intracranial hemorrhage and mortality rates did not differ between stenting group (symptomatic intracranial hemorrhage, 11.8%; mortality, 23.5%) and nonstenting group (symptomatic intracranial hemorrhage, 14.3%; mortality, 39.3%). Conclusions - Permanent stenting may be a rescue modality for stentriever-failed anterior circulation large artery occlusion. A large prospective study is necessary for confirmation because of the small sample size of this study.

AB - Background and Purpose - We hypothesized that permanent stenting may be a rescue treatment for stentriever-failed anterior circulation large artery occlusion. We compared the outcomes among patients with permanent stenting and those without stenting after stentriever failure. Methods - We retrospectively evaluated 208 patients who underwent stentriever thrombectomy for anterior circulation large artery occlusion between September 2010 and September 2015. Modified thrombolysis in cerebral ischemia 2b-3 recanalization was achieved with stentriever alone or in combination with Penumbra device in 155 patients (74.5%). An additional 8 patients (3.8%) obtained modified thrombolysis in cerebral ischemia 2b-3 with urokinase or glycoprotein IIb/IIIa inhibitor infusion. Of the remaining 45 patients (21.6%), 17 underwent stenting (stenting group; mean age, 68 years), whereas 28 did not undergo stenting (nonstenting group; mean age, 72 years). The rate of modified thrombolysis in cerebral ischemia 2b-3 in stenting group was assessed, and clinical outcomes were compared between groups. Results - There were no differences in clinical and laboratory findings, initial National Institute of Health Stroke Scale score, location of anterior circulation large artery occlusion, and onset-to-puncture time between groups. Modified thrombolysis in cerebral ischemia 2b-3 was achieved in 14 members (83.3%) of the stenting group. Stenting group had more favorable outcomes (modified Rankin Scale score 0-2, 35.3%) and less cerebral herniation (11.8%) than nonstenting group (modified Rankin Scale score 0-2, 7.1%; cerebral herniation, 42.9%; P<0.05 for both). Symptomatic intracranial hemorrhage and mortality rates did not differ between stenting group (symptomatic intracranial hemorrhage, 11.8%; mortality, 23.5%) and nonstenting group (symptomatic intracranial hemorrhage, 14.3%; mortality, 39.3%). Conclusions - Permanent stenting may be a rescue modality for stentriever-failed anterior circulation large artery occlusion. A large prospective study is necessary for confirmation because of the small sample size of this study.

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