TY - JOUR
T1 - Rescue intracranial stenting for failed posterior circulation thrombectomy
T2 - Analysis from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study
AU - Mohammaden, Mahmoud H.
AU - Tarek, Mohamed A.
AU - Aboul Nour, Hassan
AU - Haussen, Diogo C.
AU - Fifi, Johanna T.
AU - Matsoukas, Stavros
AU - Farooqui, Mudassir
AU - Ortega-Gutierrez, Santiago
AU - Zevallos, Cynthia B.
AU - Galecio-Castillo, Milagros
AU - Hassan, Ameer E.
AU - Tekle, Wondwossen
AU - Al-Bayati, Alhamza R.
AU - Salem, Mohamed M.
AU - Burkhardt, Jan Karl
AU - Pukenas, Bryan
AU - Cortez, Gustavo M.
AU - Hanel, Ricardo A.
AU - Aghaebrahim, Amin
AU - Sauvageau, Eric
AU - Hafeez, Muhammad
AU - Kan, Peter
AU - Tanweer, Omar
AU - Jumaa, Mouhammad
AU - Zaidi, Syed F.
AU - Oliver, Marion
AU - Sheth, Sunil A.
AU - Nahhas, Michael
AU - Salazar-Marioni, Sergio
AU - Khaldi, Ahmad
AU - Li, Hanzhou
AU - Kuybu, Okkes
AU - Abdalkader, Mohamad
AU - Klein, Piers
AU - Peng, Sophia
AU - Alaraj, Ali
AU - Nguyen, Thanh N.
AU - Nogueira, Raul G.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023
Y1 - 2023
N2 - Backgrounds: Recent trials have shown improved outcomes after mechanical thrombectomy (MT) for vertebrobasilar occlusion (VBO) stroke. However, there is a paucity of data regarding safety and outcomes of rescue intracranial stenting (RS) after failed MT (FRRS+) for posterior circulation stroke. We sought to compare RS to failed reperfusion without RS (FRRS-). Methods: This is a retrospective analysis of the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study, a multicenter collaboration involving prospectively collected databases. Patients were included if they had posterior circulation stroke and failed MT. The cohort was divided into two groups: FRRS+ and FRRS- (defined as modified Thrombolysis In Cerebral Infarction (mTICI) score 0-2a). The primary outcome was a shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included mRS 0-2 and mRS 0-3 at 90 days. Safety measures included rates of symptomatic intracranial hemorrhage (sICH), procedural complications, and 90-day mortality. Sensitivity and subgroup analyses were performed to identify outcomes in a matched cohort and in those with VBO, respectively. Results: A total of 152 failed thrombectomies were included in the analysis. FRRS+ (n=84) was associated with increased likelihood of lower disability (acOR 2.24, 95% CI 1.04 to 4.95, P=0.04), higher rates of mRS 0-2 (26.8% vs 12.5%, aOR 4.43, 95% CI 1.22 to 16.05, P=0.02) and mRS 0-3 (35.4% vs 18.8%, aOR 3.13, 95% CI 1.08 to 9.10, P=0.036), and lower mortality (42.7% vs 59.4%, aOR 0.40, 95% CI 0.17 to 0.97, P=0.04) at 90 days compared with FRRS- (n=68). The rates of sICH and procedural complications were comparable between the groups. Sensitivity and subgroup analyses showed similar results. Conclusion: In patients with posterior circulation stroke who had failed MT, RS resulted in better functional outcomes with comparable safety profile to procedure termination.
AB - Backgrounds: Recent trials have shown improved outcomes after mechanical thrombectomy (MT) for vertebrobasilar occlusion (VBO) stroke. However, there is a paucity of data regarding safety and outcomes of rescue intracranial stenting (RS) after failed MT (FRRS+) for posterior circulation stroke. We sought to compare RS to failed reperfusion without RS (FRRS-). Methods: This is a retrospective analysis of the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study, a multicenter collaboration involving prospectively collected databases. Patients were included if they had posterior circulation stroke and failed MT. The cohort was divided into two groups: FRRS+ and FRRS- (defined as modified Thrombolysis In Cerebral Infarction (mTICI) score 0-2a). The primary outcome was a shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included mRS 0-2 and mRS 0-3 at 90 days. Safety measures included rates of symptomatic intracranial hemorrhage (sICH), procedural complications, and 90-day mortality. Sensitivity and subgroup analyses were performed to identify outcomes in a matched cohort and in those with VBO, respectively. Results: A total of 152 failed thrombectomies were included in the analysis. FRRS+ (n=84) was associated with increased likelihood of lower disability (acOR 2.24, 95% CI 1.04 to 4.95, P=0.04), higher rates of mRS 0-2 (26.8% vs 12.5%, aOR 4.43, 95% CI 1.22 to 16.05, P=0.02) and mRS 0-3 (35.4% vs 18.8%, aOR 3.13, 95% CI 1.08 to 9.10, P=0.036), and lower mortality (42.7% vs 59.4%, aOR 0.40, 95% CI 0.17 to 0.97, P=0.04) at 90 days compared with FRRS- (n=68). The rates of sICH and procedural complications were comparable between the groups. Sensitivity and subgroup analyses showed similar results. Conclusion: In patients with posterior circulation stroke who had failed MT, RS resulted in better functional outcomes with comparable safety profile to procedure termination.
KW - Stent
KW - Stroke
KW - Thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85172335913&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85172335913&partnerID=8YFLogxK
U2 - 10.1136/jnis-2023-020676
DO - 10.1136/jnis-2023-020676
M3 - Article
C2 - 37699704
AN - SCOPUS:85172335913
SN - 1759-8478
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
M1 - inis-2023-020676
ER -