Robert Forbrig1, Hannah Lockau2, Fabian Flottmann3, Tobias Boeckh-Behrens4, Christoph Kabbasch2, Maximilian Patzig5, Anastasios Mpotsaris2,6, Jens Fiehler3, Thomas Liebig5,2,7, Goetz Thomalla8, Oezguer A Onur9, Silke Wunderlich10, Kornelia Kreiser4, Moriz Herzberg5, Frank A Wollenweber11, Sascha Prothmann4,12, Franziska Dorn5,2. 1. Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany. robert.forbrig@med.uni-muenchen.de. 2. Department of Radiology, University Hospital of Cologne, Cologne, Germany. 3. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Neuroradiology, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany. 5. Institute of Neuroradiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany. 6. Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany. 7. Department of Neuroradiology, Charité, University Hospital of Berlin, Berlin, Germany. 8. Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 9. Department of Neurology, University Hospital of Cologne, Cologne, Germany. 10. Department of Neurology, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany. 11. Neurological Clinic and Policlinic, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. 12. Institute of Diagnostic and Interventional Neuroradiology, Helios Hospital Munich West, Munich, Germany.
Abstract
PURPOSE: Stent-retriever thrombectomy (SRT) for acute intracranial large artery occlusion (LAO) may not result in permanent recanalization in rare cases, e.g. due to an underlying stenosis or dissection. In this specific patient group, rescue stent angioplasty (RSA) may be the only treatment option to achieve permanent vessel patency and potentially a good clinical outcome. To date, the experience with RSA is limited. METHODS: In this retrospective analysis, interventional and clinical data of patients with acute intracranial LAO of the anterior and posterior circulation who underwent RSA after SRT due to an underlying lesion between 2012-2017 in four neurovascular centers were studied. RESULTS: In this study 34 patients (mean age 67 years) were included whereby 18 patients had anterior circulation LAO and 16 patients posterior circulation LAO. The SRT maneuver count ranged between 1 and 15 (median 2). Indications for RSA were an immediate re-occlusion in 25 (74%), and a persistent high-grade stenosis in 9 patients (26%). The RSA was technically feasible in 33 patients (97%). A mTICI 2b/3 result was obtained in 26 patients (76%). Median onset-to-recanalization time was 248 min (range 80-650 min). After 3 months 10/34 patients (29%) had a good clinical outcome (modified Rankin Scale, mRS 0-2). In detail, 4/18 patients (22%) with anterior circulation LAO and 6/16 patients (38%) with posterior circulation LAO were functionally independent. CONCLUSION: The use of RSA can be considered for acute intracranial LAO in cases with immediate re-occlusion or high-grade stenosis after SRT alone.
PURPOSE: Stent-retriever thrombectomy (SRT) for acute intracranial large artery occlusion (LAO) may not result in permanent recanalization in rare cases, e.g. due to an underlying stenosis or dissection. In this specific patient group, rescue stent angioplasty (RSA) may be the only treatment option to achieve permanent vessel patency and potentially a good clinical outcome. To date, the experience with RSA is limited. METHODS: In this retrospective analysis, interventional and clinical data of patients with acute intracranial LAO of the anterior and posterior circulation who underwent RSA after SRT due to an underlying lesion between 2012-2017 in four neurovascular centers were studied. RESULTS: In this study 34 patients (mean age 67 years) were included whereby 18 patients had anterior circulation LAO and 16 patients posterior circulation LAO. The SRT maneuver count ranged between 1 and 15 (median 2). Indications for RSA were an immediate re-occlusion in 25 (74%), and a persistent high-grade stenosis in 9 patients (26%). The RSA was technically feasible in 33 patients (97%). A mTICI 2b/3 result was obtained in 26 patients (76%). Median onset-to-recanalization time was 248 min (range 80-650 min). After 3 months 10/34 patients (29%) had a good clinical outcome (modified Rankin Scale, mRS 0-2). In detail, 4/18 patients (22%) with anterior circulation LAO and 6/16 patients (38%) with posterior circulation LAO were functionally independent. CONCLUSION: The use of RSA can be considered for acute intracranial LAO in cases with immediate re-occlusion or high-grade stenosis after SRT alone.
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