Julian Maingard1, Kevin Phan2, Anthony Lamanna3, Hong Kuan Kok4, Christen D Barras5, Jeremy Russell6, Joshua A Hirsch7, Ronil V Chandra8, Vincent Thijs9, Mark Brooks10, Hamed Asadi11. 1. Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia. Electronic address: julian.maingard@gmail.com. 2. NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, New South Wales, Australia. 3. Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Victoria, Australia. 4. School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia; Interventional Radiology Service, Department of Radiology, Northern Hospital, Melbourne, Victoria, Australia. 5. South Australian Institute of Health and Medical Research, Adelaide, South Australia, Australia; School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia. 6. Department of Neurosurgery, Austin Hospital, Melbourne, Victoria, Australia. 7. Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 8. Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia; Department of Imaging, Monash University, Melbourne, Victoria, Australia. 9. Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; School of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Department of Neurology, Austin Health, Melbourne, Victoria, Australia. 10. School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia; Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; School of Medicine, University of Melbourne, Melbourne, Victoria, Australia. 11. Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia; Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: Up to 20% of patients fail to achieve reperfusion with modified Thrombolysis in Cerebral Infarction (mTICI) scores of 0-1 after mechanical thrombectomy (MT). Furthermore, underlying intracranial atherosclerotic disease, particularly when associated with >70% residual or flow limiting stenosis, is associated with higher rates of failed MT and high failure risk MT. The aim of this study was to systematically review the procedural and clinical outcomes in patients with failed MT and high failure risk MT. We also explored differences between patients receiving acute rescue stenting compared with medical management alone. METHODS: A systematic literature search was conducted in Ovid MEDLINE, PubMed, Embase, and Cochrane online scientific publication databases for English language publications from their date of inception until October 2018. Studies including adult patients with acute ischemic stroke because of emergent large vessel occlusion with failed (mTICI score 0-1) or high failure risk MT within the anterior circulation who underwent rescue stenting were included. A systematic review and meta-analysis of proportions was performed. RESULTS: Rescue intracranial stenting after failed MT or high failure risk MT results in improved clinical outcomes compared with patients without stenting (48.5% vs. 19.7%, respectively; P < 0.001), without an increase in the rate of symptomatic intracranial hemorrhage, despite additional use of antiplatelet agents (9.7% vs. 14.1%, respectively; P = 0.04). CONCLUSIONS: In patients who fail initial attempts at MT or are high risk for acute reocclusion, rescue intracranial stenting could be considered with the aim to improve functional outcomes. Antiplatelet agents do not increase the risk of hemorrhage in these patients.
BACKGROUND: Up to 20% of patients fail to achieve reperfusion with modified Thrombolysis in Cerebral Infarction (mTICI) scores of 0-1 after mechanical thrombectomy (MT). Furthermore, underlying intracranial atherosclerotic disease, particularly when associated with >70% residual or flow limiting stenosis, is associated with higher rates of failed MT and high failure risk MT. The aim of this study was to systematically review the procedural and clinical outcomes in patients with failed MT and high failure risk MT. We also explored differences between patients receiving acute rescue stenting compared with medical management alone. METHODS: A systematic literature search was conducted in Ovid MEDLINE, PubMed, Embase, and Cochrane online scientific publication databases for English language publications from their date of inception until October 2018. Studies including adult patients with acute ischemic stroke because of emergent large vessel occlusion with failed (mTICI score 0-1) or high failure risk MT within the anterior circulation who underwent rescue stenting were included. A systematic review and meta-analysis of proportions was performed. RESULTS: Rescue intracranial stenting after failed MT or high failure risk MT results in improved clinical outcomes compared with patients without stenting (48.5% vs. 19.7%, respectively; P < 0.001), without an increase in the rate of symptomatic intracranial hemorrhage, despite additional use of antiplatelet agents (9.7% vs. 14.1%, respectively; P = 0.04). CONCLUSIONS: In patients who fail initial attempts at MT or are high risk for acute reocclusion, rescue intracranial stenting could be considered with the aim to improve functional outcomes. Antiplatelet agents do not increase the risk of hemorrhage in these patients.
Authors: Samuel Pearce; Julian T Maingard; Hong Kuan Kok; Christen D Barras; Jeremy H Russell; Joshua A Hirsch; Ronil V Chandra; Ash Jhamb; Vincent Thijs; Mark Brooks; Hamed Asadi Journal: Clin Neuroradiol Date: 2021-03-01 Impact factor: 3.649
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Authors: G Marnat; F Delvoye; S Finitsis; B Lapergue; F Gariel; A Consoli; J-P Desilles; M Mazighi; C Dargazanli; R Bourcier; J Darcourt; V Chalumeau; M Elhorany; F Clarençon; S Richard; B Gory; I Sibon Journal: AJNR Am J Neuroradiol Date: 2021-06-11 Impact factor: 4.966