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Clinical outcomes of rescue stenting for failed endovascular thrombectomy: a multicenter prospective registry

Authors
 Jang-Hyun Baek  ;  Byung Moon Kim  ;  Eun Hyun Ihm  ;  Chang-Hyun Kim  ;  Dong Joon Kim  ;  Ji Hoe Heo  ;  Hyo Suk Nam  ;  Young Dae Kim  ;  Sangil Suh  ;  Byungjun Kim  ;  Yoodong Won  ;  Byung Hyun Baek  ;  Woong Yoon  ;  Hyon-Jo Kwon  ;  Yoonkyung Chang  ;  Cheolkyu Jung  ;  Hae Woong Jeong 
Citation
 JOURNAL OF NEUROINTERVENTIONAL SURGERY, Vol.14(12) : 1166-1172, 2022-12 
Journal Title
JOURNAL OF NEUROINTERVENTIONAL SURGERY
ISSN
 1759-8478 
Issue Date
2022-12
MeSH
Endovascular Procedures* / adverse effects ; Glycoproteins ; Humans ; Registries ; Retrospective Studies ; Stents / adverse effects ; Stroke* / diagnostic imaging ; Stroke* / surgery ; Thrombectomy / adverse effects ; Treatment Outcome
Keywords
atherosclerosis ; stent ; stroke ; thrombectomy
Abstract
Background: Mechanical thrombectomy (MT) is a primary endovascular modality for acute intracranial large vessel occlusion. However, further treatment, such as rescue stenting, is occasionally necessary for refractory cases. We aimed to investigate the efficacy and safety of rescue stenting in first-line MT failure and to identify the clinical factors affecting its clinical outcome.

Methods: A multicenter prospective registry was designed for this study. We enrolled consecutive patients who underwent rescue stenting for first-line MT failure. Endovascular details and outcomes, follow-up patency of the stented artery, and clinical outcomes were summarized and compared between the favorable and unfavorable outcome groups.

Results: A total of 78 patients were included. Intracranial atherosclerotic stenosis was the most common etiology for rescue stenting (97.4%). Seventy-seven patients (98.7%) were successfully recanalized by rescue stenting. A favorable outcome was observed in 66.7% of patients. Symptomatic intracranial hemorrhage and mortality were observed in 5.1% and 4.0% of patients, respectively. The stented artery was patent in 82.1% of patients on follow-up angiography. In a multivariable analysis, a patent stent on follow-up angiography was an independent factor for a favorable outcome (OR 87.6; 95% CI 4.77 to 1608.9; p=0.003). Postprocedural intravenous maintenance of glycoprotein IIb/IIIa inhibitor was significantly associated with the follow-up patency of the stented artery (OR 5.72; 95% CI 1.45 to 22.6; p=0.013).

Conclusions: In this multicenter prospective registry, rescue stenting for first-line MT failure was effective and safe. For a favorable outcome, follow-up patency of the stented artery was important, which was significantly associated with postprocedural maintenance of glycoprotein IIb/IIIa inhibitors.
Full Text
https://jnis.bmj.com/content/14/12/1166.long
DOI
10.1136/neurintsurg-2021-018308
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 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
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/192837
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