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. 2023 Jan 10:13:1001496.
doi: 10.3389/fneur.2022.1001496. eCollection 2022.

Rescue stenting after the failure of mechanical thrombectomy to treat acute intracranial atherosclerotic occlusion

Shunyuan Guo  1   2 , Tianyu Jin  3 , Chao Xu  2 , Wei Huang  4 , Zongjie Shi  2 , Yu Geng  2
Affiliations

Rescue stenting after the failure of mechanical thrombectomy to treat acute intracranial atherosclerotic occlusion

Shunyuan Guo et al. Front Neurol. .

Abstract

Background: Acute ischemic stroke (AIS) with intracranial large vessel occlusion (LVO) is refractory to reperfusion because of the underlying intracranial atherosclerosis (ICAS), and this condition often requires salvage methods such as balloon angioplasty and rescue stenting (RS). In this study, we investigated the short-term outcomes of RS after failed mechanical thrombectomy (MT) for the treatment of acute intracranial atherosclerotic occlusion.

Methods: We retrospectively evaluated the clinical data of 127 patients who underwent MT for acute intracranial atherosclerotic occlusion in our hospital between August 2018 and January 2022. The degree of recanalization was evaluated immediately after the treatment by Modified Thrombolysis in Cerebral Infarction (mTICI). The modified Rankin Scale (mRS) was used 90 days after treatment to evaluate the neurological functions. In addition, the incidence of symptomatic intracranial hemorrhage (sICH) and postoperative mortality within 90 days of treatment were calculated.

Results: Among the 127 patients, 86 patients (67.7%) had revascularization (mTICI 2b-3) immediately after MT (non-RS group), and RS was performed in 41 patients (32.3%) after MT failure (RS group). No difference in the sICH rate was observed between the two groups (17.1 vs. 16.3%, p = 0.91). There was a slightly higher mortality rate in the RS group (14.6 vs. 12.8%, p = 0.71); however, the difference was not significant. There was no difference in the proportion of patients in the RS and non-RS groups who had a 90-day mRS score of 0-2 (48.8 vs. 52.3%, p = 0.76).

Conclusions: Rescue stenting after MT failure might be a feasible rescue modality for treating acute intracranial atherosclerotic occlusion.

Keywords: acute ischemic stroke; intracranial atherosclerosis; mechanical thrombectomy; rescue stenting; symptomatic intracerebral hemorrhage.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Elderly patient with an acute onset of left body weakness, numbness, and difficulty speaking (NIHSS 7). The ASPECTS was 9 based on CT scan. (A) AP right carotid angiogram clearly showed an occlusion of the M1 segment of the right MCA. (B) Revealed the post failed MT with stenosis. (C) The red arrow shows the proximal and distal legs of the stent. (D) AP right carotid angiogram depicting recanalization of the right MCA and its branches (mTICI 3).
Figure 2
Figure 2
Flow chart of the MT process in out center. AIS, acute ischemic stroke; LVO, intracranial large vessel occlusion; CT, computed tomography; CTA, computed tomographic angiography; DSA, digital subtraction angiography; MT, mechanical thrombectomy; rtPA, recombinant tissue plasminogen activator. MT +/ iv rt PA, iv rtPA is performed if the patient is within 4.5 h of onset.
Figure 3
Figure 3
Flow chart of patient inclusion in the study. LVO, intracranial large vessel occlusion; RS, rescue stenting.
See this image and copyright information in PMC

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References

    1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. . Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of a cute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. (2019) 50:e344–418. 10.1161/STR.0000000000000211 - DOI - PubMed
    1. Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, et al. . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. (2016) 387:1723–31. 10.1016/S0140-6736(16)00163-X - DOI - PubMed
    1. Zaidat OO, Bozorgchami H, Ribó M, Saver JL, Mattle HP, Chapot R, et al. . Primary results of the multicenter arise ii study (analysis of revascularization in ischemic stroke with embotrap). Stroke. (2018) 49:1107–15. 10.1161/STROKEAHA.117.020125 - DOI - PubMed
    1. Jia B, Feng L, Liebeskind DS, Huo X, Gao F, Ma N, et al. . Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis. J Neurointervent Surg. (2018) 10:746–50. 10.1136/neurintsurg-2017-013489 - DOI - PubMed
    1. Woo HG, Sunwoo L, Jung C, Kim BJ, Han MK, Bae HJ, et al. . Feasibility of permanent stenting with solitaire fr as a rescue treatment for the reperfusion of acute intracranial artery occlusion. AJNR Am J Neuroradiol. (2018) 39:331–6. 10.3174/ajnr.A5477 - DOI - PMC - PubMed

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