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)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024/9/17
Y1 - 2024/9/17
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 - https://www.scopus.com/pages/publications/85172335913
UR - https://www.scopus.com/pages/publications/85172335913#tab=citedBy
U2 - 10.1136/jnis-2023-020676
DO - 10.1136/jnis-2023-020676
M3 - Article
C2 - 37699704
AN - SCOPUS:85172335913
SN - 1759-8478
VL - 16
SP - 974
EP - 980
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
IS - 10
ER -