Jang-Hyun Baek1, Byung Moon Kim2, Dong Joon Kim1, Ji Hoe Heo1, Hyo Suk Nam1, Joonsang Yoo1. 1. From the Department of Neurology, National Medical Center, Seoul, South Korea (J.-H.B.); and Department of Radiology (B.M.K., D.J.K.) and Department of Neurology (J.H.H., H.S.N., J.Y.), Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea. 2. From the Department of Neurology, National Medical Center, Seoul, South Korea (J.-H.B.); and Department of Radiology (B.M.K., D.J.K.) and Department of Neurology (J.H.H., H.S.N., J.Y.), Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea. bmoon21@hanmail.net.
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.
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.
Authors: G Marnat; S Finistis; F Delvoye; I Sibon; J-P Desilles; M Mazighi; F Gariel; A Consoli; C Rosso; F Clarençon; M Elhorany; C Denier; V Chalumeau; J Caroff; L Veunac; F Bourdain; J Darcourt; J-M Olivot; R Bourcier; C Dargazanli; C Arquizan; S Richard; B Lapergue; B Gory Journal: AJNR Am J Neuroradiol Date: 2022-03-03 Impact factor: 3.825