Claudio Baracchini1, Filippo Farina2, Matteo Soso2, Federica Viaro2, Silvia Favaretto2, Anna Palmieri2, Caterina Kulyk2, Enzo Ballotta3, Lorena Nico4, Giacomo Cester4, Francesco Causin4. 1. Department of Neuroscience, University of Padua School of Medicine, Padua, Italy. Electronic address: claudiobaracchini@gmail.com. 2. Department of Neuroscience, University of Padua School of Medicine, Padua, Italy. 3. Vascular Study Group, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua School of Medicine, Padua, Italy. 4. Neuroradiology Unit, University of Padua School of Medicine, Padua, Italy.
Abstract
BACKGROUND AND OBJECTIVE: Stentriever thrombectomy failure in patients with acute ischemic stroke caused by anterior circulation large artery occlusion is not a rare event. The purpose of this study was to investigate whether other procedures (tirofiban, permanent stenting) are able to recanalize the occluded vessel and determine a better outcome without increasing mortality and intracranial hemorrhage rates. METHODS: Among 513 patients consecutively admitted with anterior circulation stroke, 109 underwent stentriever thrombectomy. Modified Thrombolysis in Cerebral Ischemia (mTICI) 2b-3 recanalization was achieved in 60 patients (55.0%, group 1). Only 3 of 19 patients (group 2) obtained additional recanalization with intra-arterial infusion of tirofiban. The remaining 46 either underwent permanent stenting (n = 23, group 3) or were left nonrecanalized (n = 23, group 4). The rate of mTICI 2b-3 and clinical outcomes were analyzed in the different groups. RESULTS: A successful recanalization (mTICI 2b-3) was achieved in 17 patients of group 3 (73.9%). A significantly better outcome was observed in group 3 (modified Rankin Scale [mRS] score, 0-2) than in group 4 at 3 months (56.5% vs. 17.4%). Symptomatic intracranial hemorrhage rates were not different between group 3 and group 4 (4.3% vs. 4.3%), whereas there was a significantly higher mortality in group 4 than in group 3 (39.1% vs. 4.3%). On multivariate analysis, permanent stenting was the only factor independently associated with favorable outcome and mortality. CONCLUSIONS: Permanent stenting might be a feasible solution in patients with acute large artery occlusion after stentriever thrombectomy failure.
BACKGROUND AND OBJECTIVE:Stentriever thrombectomy failure in patients with acute ischemic stroke caused by anterior circulation large artery occlusion is not a rare event. The purpose of this study was to investigate whether other procedures (tirofiban, permanent stenting) are able to recanalize the occluded vessel and determine a better outcome without increasing mortality and intracranial hemorrhage rates. METHODS: Among 513 patients consecutively admitted with anterior circulation stroke, 109 underwent stentriever thrombectomy. Modified Thrombolysis in Cerebral Ischemia (mTICI) 2b-3 recanalization was achieved in 60 patients (55.0%, group 1). Only 3 of 19 patients (group 2) obtained additional recanalization with intra-arterial infusion of tirofiban. The remaining 46 either underwent permanent stenting (n = 23, group 3) or were left nonrecanalized (n = 23, group 4). The rate of mTICI 2b-3 and clinical outcomes were analyzed in the different groups. RESULTS: A successful recanalization (mTICI 2b-3) was achieved in 17 patients of group 3 (73.9%). A significantly better outcome was observed in group 3 (modified Rankin Scale [mRS] score, 0-2) than in group 4 at 3 months (56.5% vs. 17.4%). Symptomatic intracranial hemorrhage rates were not different between group 3 and group 4 (4.3% vs. 4.3%), whereas there was a significantly higher mortality in group 4 than in group 3 (39.1% vs. 4.3%). On multivariate analysis, permanent stenting was the only factor independently associated with favorable outcome and mortality. CONCLUSIONS: Permanent stenting might be a feasible solution in patients with acute large artery occlusion after stentriever thrombectomy failure.
Authors: Christian Paul Stracke; Jens Fiehler; Lukas Meyer; Götz Thomalla; Lars Udo Krause; Stephan Lowens; Jan Rothaupt; Byung Moon Kim; Ji Hoe Heo; Leonard L L Yeo; Tommy Andersson; Christoph Kabbasch; Franziska Dorn; Rene Chapot; Uta Hanning Journal: J Am Heart Assoc Date: 2020-03-03 Impact factor: 5.501
Authors: Sandra A Cornelissen; Tommy Andersson; Ake Holmberg; Patrick A Brouwer; Michael Söderman; Pervinder Bhogal; Leonard L L Yeo Journal: Clin Neuroradiol Date: 2018-05-29 Impact factor: 3.649
Authors: Jin Soo Lee; Seong-Joon Lee; Ji Man Hong; Francisco José Arruda Mont Alverne; Fabricio Oliveira Lima; Raul G Nogueira Journal: J Stroke Date: 2022-01-31 Impact factor: 6.967