Sergio Nappini1, Nicola Limbucci2, Giuseppe Leone3, Andrea Rosi4, Leonardo Renieri5, Arturo Consoli6, Antonio Laiso7, Iacopo Valente8, Francesco Rosella9, Riccardo Rosati10, Salvatore Mangiafico11. 1. Neurovascular Interventional Unit, Careggi University Hospital, Florence. Largo P. Palagi, 1-50134 Florence, Italy. Electronic address: nappini@gmail.com. 2. Neurovascular Interventional Unit, Careggi University Hospital, Florence. Largo P. Palagi, 1-50134 Florence, Italy. Electronic address: nicolalimb@gmail.com. 3. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy. Electronic address: g.leonemd@gmail.com. 4. Neurovascular Interventional Unit, Careggi University Hospital, Florence. Largo P. Palagi, 1-50134 Florence, Italy. Electronic address: andrea.rosi87@gmail.com. 5. Neurovascular Interventional Unit, Careggi University Hospital, Florence. Largo P. Palagi, 1-50134 Florence, Italy. Electronic address: leonardo.renieri@hotmail.it. 6. Neurovascular Interventional Unit, Careggi University Hospital, Florence. Largo P. Palagi, 1-50134 Florence, Italy. Electronic address: onemed21@gmail.com. 7. Neurovascular Interventional Unit, Careggi University Hospital, Florence. Largo P. Palagi, 1-50134 Florence, Italy. Electronic address: antoniolaiso07@gmail.com. 8. Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital-Catholic University, Rome, Italy. Electronic address: iacopovalentemd@gmail.com. 9. Department of Bioimaging and Radiological Sciences, Institute of Radiology, "A. Gemelli" Hospital-Catholic University, Rome, Italy. Electronic address: francesco.rosella.md@gmail.com. 10. Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy. Electronic address: dopliker@yahoo.it. 11. Neurovascular Interventional Unit, Careggi University Hospital, Florence. Largo P. Palagi, 1-50134 Florence, Italy. Electronic address: mangiax@libero.it.
Abstract
BACKGROUND: Recent trials established the efficacy of mechanical stent-retriever thrombectomy for treatment of stroke patients with large vessel occlusion (LVO) in the anterior circulation. However, stent-retriever thrombectomy may not accomplish successful recanalization in all patients. The aim of this study is to report the role of bail-out permanent stenting after failure of mechanical thrombectomy. METHODS: Among 430 patients included in a prospectively maintained database, we analysed 325 cases of anterior circulation LVO. Mechanical thrombectomy (mTICI 2b-3) was effective in 213/325 (65%) and failed in 112/325 (35%). Bail-out intracranial stenting was performed in 17/325 (5.2%) patients. In all cases a fully retrievable detachable stent was used (Solitaire AB, Medtronic). RESULTS: No intraprocedural technical complications occurred. Successful reperfusion (mTICI 2b/3) was achieved in 12/17 patients (70.6%). Three (17.6%) patients died: one extensive infarction in the internal carotid artery territory, one large intracerebral haemorrhage, and one massive pulmonary embolism. Haemorrhagic conversion, both symptomatic and asymptomatic, occurred in 2/17 (11.7%). Good clinical outcome (mRS 0-2) at 3-months was achieved in 41.2% of patients. CONCLUSION: Bail-out intracranial stenting after unsuccessful thrombectomy is technically feasible and the associated haemorrhagic risk seems acceptable in selected patients. We suggest that bail-out intracranial stenting, is safe and effective in selected patients with LVO stroke who failed to respond to thrombectomy.
BACKGROUND: Recent trials established the efficacy of mechanical stent-retriever thrombectomy for treatment of strokepatients with large vessel occlusion (LVO) in the anterior circulation. However, stent-retriever thrombectomy may not accomplish successful recanalization in all patients. The aim of this study is to report the role of bail-out permanent stenting after failure of mechanical thrombectomy. METHODS: Among 430 patients included in a prospectively maintained database, we analysed 325 cases of anterior circulation LVO. Mechanical thrombectomy (mTICI 2b-3) was effective in 213/325 (65%) and failed in 112/325 (35%). Bail-out intracranial stenting was performed in 17/325 (5.2%) patients. In all cases a fully retrievable detachable stent was used (Solitaire AB, Medtronic). RESULTS: No intraprocedural technical complications occurred. Successful reperfusion (mTICI 2b/3) was achieved in 12/17 patients (70.6%). Three (17.6%) patients died: one extensive infarction in the internal carotid artery territory, one large intracerebral haemorrhage, and one massive pulmonary embolism. Haemorrhagic conversion, both symptomatic and asymptomatic, occurred in 2/17 (11.7%). Good clinical outcome (mRS 0-2) at 3-months was achieved in 41.2% of patients. CONCLUSION: Bail-out intracranial stenting after unsuccessful thrombectomy is technically feasible and the associated haemorrhagic risk seems acceptable in selected patients. We suggest that bail-out intracranial stenting, is safe and effective in selected patients with LVO stroke who failed to respond to thrombectomy.
Authors: Mayank Goyal; Kirill Orlov; Mary E Jensen; Allan Taylor; Charles Majoie; Mahesh Jayaraman; Jianmin Liu; Geneviève Milot; Patrick Brouwer; Shinichi Yoshimura; Felipe Albuquerque; Adam Arthur; David Kallmes; Nobuyuki Sakai; Justin F Fraser; Raul Nogueira; Pengfei Yang; Franziska Dorn; Lucie Thibault; Jens Fiehler; René Chapot; Johanna Maria Ospel Journal: Neuroradiology Date: 2020-09-24 Impact factor: 2.804
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