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Stenting as a Rescue Treatment After Failure of Mechanical Thrombectomy for Anterior Circulation Large Artery Occlusion

Authors
 Jang-Hyun Baek  ;  Byung Moon Kim  ;  Dong Joon Kim  ;  Ji Hoe Heo  ;  Hyo Suk Nam  ;  Joonsang Yoo 
Citation
 STROKE, Vol.47(9) : 2360-2363, 2016 
Journal Title
 STROKE 
ISSN
 0039-2499 
Issue Date
2016
MeSH
Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Brain/diagnostic imaging* ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/drug therapy ; Brain Ischemia/surgery* ; Combined Modality Therapy ; Computed Tomography Angiography ; Female ; Fibrinolytic Agents/therapeutic use ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Registries ; Retreatment ; Retrospective Studies ; Stents* ; Stroke/diagnostic imaging ; Stroke/drug therapy ; Stroke/surgery* ; Thrombectomy/methods* ; Treatment Failure ; Treatment Outcome ; Urokinase-Type Plasminogen Activator/therapeutic use
Keywords
stents ; stroke ; thrombectomy
Abstract
BACKGROUND AND PURPOSE: We hypothesized that permanent stenting may be a rescue treatment for stentriever-failed anterior circulation large artery occlusion. We compared the outcomes among patients with permanent stenting and those without stenting after stentriever failure. METHODS: We retrospectively evaluated 208 patients who underwent stentriever thrombectomy for anterior circulation large artery occlusion between September 2010 and September 2015. Modified thrombolysis in cerebral ischemia 2b-3 recanalization was achieved with stentriever alone or in combination with Penumbra device in 155 patients (74.5%). An additional 8 patients (3.8%) obtained modified thrombolysis in cerebral ischemia 2b-3 with urokinase or glycoprotein IIb/IIIa inhibitor infusion. Of the remaining 45 patients (21.6%), 17 underwent stenting (stenting group; mean age, 68 years), whereas 28 did not undergo stenting (nonstenting group; mean age, 72 years). The rate of modified thrombolysis in cerebral ischemia 2b-3 in stenting group was assessed, and clinical outcomes were compared between groups. RESULTS: There were no differences in clinical and laboratory findings, initial National Institute of Health Stroke Scale score, location of anterior circulation large artery occlusion, and onset-to-puncture time between groups. Modified thrombolysis in cerebral ischemia 2b-3 was achieved in 14 members (83.3%) of the stenting group. Stenting group had more favorable outcomes (modified Rankin Scale score 0-2, 35.3%) and less cerebral herniation (11.8%) than nonstenting group (modified Rankin Scale score 0-2, 7.1%; cerebral herniation, 42.9%; P<0.05 for both). Symptomatic intracranial hemorrhage and mortality rates did not differ between stenting group (symptomatic intracranial hemorrhage, 11.8%; mortality, 23.5%) and nonstenting group (symptomatic intracranial hemorrhage, 14.3%; mortality, 39.3%). CONCLUSIONS: Permanent stenting may be a rescue modality for stentriever-failed anterior circulation large artery occlusion. A large prospective study is necessary for confirmation because of the small sample size of this study.
Full Text
http://stroke.ahajournals.org/content/47/9/2360
DOI
10.1161/STROKEAHA.116.014073
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Yoo, Joon Sang(유준상)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/151911
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