Yoonkyung Chang1, Byung Moon Kim2, Oh Young Bang1, Jang-Hyun Baek1, Ji Hoe Heo1, Hyo Suk Nam1, Young Dae Kim1, Joonsang Yoo1, Dong Joon Kim1, Pyoung Jeon1, Seung Kug Baik1, Sang Hyun Suh1, Kyung-Yul Lee1, Hyo Sung Kwak1, Hong Gee Roh1, Young-Jun Lee1, Sang Heum Kim1, Chang-Woo Ryu1, Yon-Kwon Ihn1, Byungjun Kim1, Hong Jun Jeon1, Jin Woo Kim1, Jun Soo Byun1, Sangil Suh1, Jeong Jin Park1, Woong Jae Lee1, Jieun Roh1, Byoung-Soo Shin1, Jeong-Min Kim1. 1. From the Department of Radiology, Severance Stroke Center, Severance Hospital (Y.C., B.M.K., D.J.K.), Department of Neurology, Severance Stroke Center, Severance Hospital (J.H.H., H.S.N., Y.D.K), and Department of Neurology, Gangnam Severance Hospital (K.-Y.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (O.Y.B.) and Department of Radiology (P.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Neurology, National Medical Center, Seoul, South Korea (J.-H.B.); Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea (J.Y.); Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (S.K.B., J.R.); Department of Radiology, Gangnam Severance Hospital, Yonsei University, Seoul, South Korea (S.H.S.); Department of Radiology (H.S.K.) and Department of Neurology (B.-S.S.), Chonbuk National University Medical School and Hospital, Jeonju, South Korea; Department of Radiology, Konkuk University Medical Center and School of Medicine, Seoul, South Korea (H.G.R.); Department of Radiology, Hanyang University College of Medicine and Hospital, Seoul, Korea (Y.-J.L.); Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea (S.H.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea (C.W.R.); Department of Radiology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea (Y.-K.I.); Department of Radiology, Korea University Anam Hospital, Seoul, South Korea (B.K.); Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (H.-J.J.); Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.W.K.); Department of Radiology (J.S.B., W.J.L.) and Department of Neurology (J.-M.K.), Chung-Ang University Hospital, Seoul, South Korea; Department of Radiology, Korea University College of Medicine, Guro Hospital, Seoul, South Korea (S.S.); and Department of Neurology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, South Korea (J.J.P.). 2. From the Department of Radiology, Severance Stroke Center, Severance Hospital (Y.C., B.M.K., D.J.K.), Department of Neurology, Severance Stroke Center, Severance Hospital (J.H.H., H.S.N., Y.D.K), and Department of Neurology, Gangnam Severance Hospital (K.-Y.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (O.Y.B.) and Department of Radiology (P.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Neurology, National Medical Center, Seoul, South Korea (J.-H.B.); Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea (J.Y.); Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (S.K.B., J.R.); Department of Radiology, Gangnam Severance Hospital, Yonsei University, Seoul, South Korea (S.H.S.); Department of Radiology (H.S.K.) and Department of Neurology (B.-S.S.), Chonbuk National University Medical School and Hospital, Jeonju, South Korea; Department of Radiology, Konkuk University Medical Center and School of Medicine, Seoul, South Korea (H.G.R.); Department of Radiology, Hanyang University College of Medicine and Hospital, Seoul, Korea (Y.-J.L.); Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea (S.H.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea (C.W.R.); Department of Radiology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea (Y.-K.I.); Department of Radiology, Korea University Anam Hospital, Seoul, South Korea (B.K.); Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (H.-J.J.); Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.W.K.); Department of Radiology (J.S.B., W.J.L.) and Department of Neurology (J.-M.K.), Chung-Ang University Hospital, Seoul, South Korea; Department of Radiology, Korea University College of Medicine, Guro Hospital, Seoul, South Korea (S.S.); and Department of Neurology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, South Korea (J.J.P.). bmoon21@hanmail.net.
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 identified 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 findings 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 significantly higher rate of good outcome (modified 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% confidence 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 significantly 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.
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 identified 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 findings 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 significantly higher rate of good outcome (modified 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% confidence 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 significantly 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.
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