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Rescue Stenting for Failed Mechanical Thrombectomy in Acute Ischemic Stroke: A Multicenter Experience

Authors
 Yoonkyung Chang  ;  Byung Moon Kim  ;  Oh Young Bang  ;  Jang-Hyun Baek  ;  Ji Hoe Heo  ;  Hyo Suk Nam  ;  Young Dae Kim  ;  Joonsang Yoo  ;  Dong Joon Kim  ;  Pyoung Jeon  ;  Seung Kug Baik  ;  Sang Hyun Suh  ;  Kyung-Yul Lee  ;  Hyo Sung Kwak  ;  Hong Gee Roh  ;  Young-Jun Lee  ;  Sang Heum Kim  ;  Chang-Woo Ryu  ;  Yon-Kwon Ihn  ;  Byungjun Kim  ;  Hong Jun Jeon  ;  Jin Woo Kim  ;  Jun Soo Byun  ;  Sangil Suh  ;  Jeong Jin Park  ;  Woong Jae Lee  ;  Jieun Roh  ;  Byoung-Soo Shin  ;  Jeong-Min Kim 
Citation
 Stroke, Vol.49(4) : 958-964, 2018 
Journal Title
 Stroke 
ISSN
 0039-2499 
Issue Date
2018
Keywords
middle cerebral artery ; stents ; stroke ; thrombectomy
Abstract
BACKGROUND AND PURPOSE: Effective rescue treatment has not yet been suggested in patients with mechanical thrombectomy (MT) failure. This study aimed to test whether rescue stenting (RS) improved clinical outcomes in MT-failed patients. METHODS: This is a retrospective analysis of the cohorts of the 16 comprehensive stroke centers between September 2010 and December 2015. We identified the patients who underwent MT but failed to recanalize intracranial internal carotid artery or middle cerebral artery M1 occlusion. Patients were dichotomized into 2 groups: patients with RS and without RS after MT failure. Clinical and laboratory findings and outcomes were compared between the 2 groups. It was tested whether RS is associated with functional outcome. RESULTS: MT failed in 148 (25.0%) of the 591 patients with internal carotid artery or middle cerebral artery M1 occlusion. Of these 148 patients, 48 received RS (RS group) and 100 were left without further treatment (no stenting group). Recanalization was successful in 64.6% (31 of 48 patients) of RS group. Compared with no stenting group, RS group showed a significantly higher rate of good outcome (modified Rankin Scale score, 0-2; 39.6% versus 22.0%; P=0.031) without increasing symptomatic intracranial hemorrhage (16.7% versus 20.0%; P=0.823) or mortality (12.5% versus 19.0%; P=0.360). Of the RS group, patients who had recanalization success had 54.8% of good outcome, which is comparable to that (55.4%) of recanalization success group with MT. RS remained independently associated with good outcome after adjustment of other factors (odds ratio, 3.393; 95% confidence interval, 1.192-9.655; P=0.022). Follow-up vascular imaging was available in the 23 (74.2%) of 31 patients with recanalization success with RS. The stent was patent in 20 (87.0%) of the 23 patients. Glycoprotein IIb/IIIa inhibitor was significantly associated with stent patency but not with symptomatic intracranial hemorrhage. CONCLUSIONS: RS was independently associated with good outcomes without increasing symptomatic intracranial hemorrhage or mortality. RS seemed considered in MT-failed internal carotid artery or middle cerebral artery M1 occlusion.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/162339
Full Text
https://www.ahajournals.org/doi/10.1161/STROKEAHA.117.020072
DOI
10.1161/strokeaha.117.020072
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실)
Yonsei Authors
김동준(Kim, Dong Joon) ORCID logo https://orcid.org/0000-0002-7035-087X
김병문(Kim, Byung Moon) ORCID logo https://orcid.org/0000-0001-8593-6841
김영대(Kim, Young Dae)
남효석(Nam, Hyo Suk) ORCID logo https://orcid.org/0000-0002-4415-3995
서상현(Suh, Sang Hyun) ORCID logo https://orcid.org/0000-0002-7098-4901
이경열(Lee, Kyung Yul) ORCID logo https://orcid.org/0000-0001-5585-7739
허지회(Heo, Ji Hoe) ORCID logo https://orcid.org/0000-0001-9898-3321
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