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Multicenter Study
. 2021 Jun 15;10(12):e020195.
doi: 10.1161/JAHA.120.020195. Epub 2021 Jun 5.

Outcomes of Rescue Endovascular Treatment of Emergent Large Vessel Occlusion in Patients With Underlying Intracranial Atherosclerosis: Insights From STAR

Sami Al Kasab  1   2 , Eyad Almallouhi  1   2 , Ali Alawieh  3 , Stacey Wolfe  4 , Kyle M Fargen  4 , Adam S Arthur  5 , Nitin Goyal  5   6 , Travis Dumont  7 , Peter Kan  8 , Joon-Tae Kim  9 , Reade De Leacy  10 , Ilko Maier  11 , Joshua Osbun  12 , Ansaar Rai  13 , Pascal Jabbour  14 , Jonathan A Grossberg  3 , Min S Park  15 , Robert M Starke  16 , Roberto Crosa  17 , Alejandro M Spiotta  2 ; STAR collaborators †
Collaborators, Affiliations
Multicenter Study

Outcomes of Rescue Endovascular Treatment of Emergent Large Vessel Occlusion in Patients With Underlying Intracranial Atherosclerosis: Insights From STAR

Sami Al Kasab et al. J Am Heart Assoc. .

Abstract

Background Some emergent large vessel occlusions (ELVOs) are refractory to reperfusion because of underlying intracranial atherosclerosis (ICAS), often requiring rescue therapy (RT) with balloon angioplasty, stenting, or both. In this study, we investigate the safety, efficacy, and long-term outcomes of RT in the setting of mechanical thrombectomy for ICAS-related ELVO. Methods and Results We queried the databases of 10 thrombectomy-capable centers in North America and Europe included in STAR (Stroke Thrombectomy and Aneurysm Registry). Patients with ELVO who underwent ICAS-related RT were included. A matched sample was produced for variables of age, admission National Institute of Health Stroke Scale, Alberta Stroke Program Early CT Score, onset to groin puncture time, occlusion site, and final recanalization. Out of 3025 patients with MT, 182 (6%) patients required RT because of underlying ICAS. Balloon angioplasty was performed on 122 patients, and 117 patients had intracranial stenting. In the matched analysis, 141 patients who received RT matched to a similar number of controls. The number of thrombectomy passes was higher (3 versus 1, P<0.001), and procedural time was longer in the RT group (52 minutes versus 36 minutes, P=0.004). There was a higher rate of symptomatic hemorrhagic transformation in the RT group (7.8% versus 4.3%, P=0.211), however, the difference was not significant. There was no difference in 90-day modified Rankin scale of 0 to 2 (44% versus 47.5%, P=0.543) between patients in the RT and control groups. Conclusions In patients with ELVO with underlying ICAS requiring RT, despite longer procedure time and a more thrombectomy passes, the 90 days favorable outcomes were comparable with patients with embolic ELVO.

Keywords: acute stroke; balloon angioplasty; intracranial atherosclerosis; mechanical thrombectomy; rescue therapy; stenting.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1. The distribution of 90‐day modified Rankin scale in the rescue therapy secondary to intracranial atherosclerosis group compared with the control group.
ICAS indicates intracranial atherosclerosis mRS, modified Rankin scale; and RT, rescue therapy.
See this image and copyright information in PMC

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