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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Rescue Stenting for Failed Mechanical Thrombectomy in Acute Ischemic Stroke: A Multicenter Experience
Yoonkyung Chang1, Byung Moon Kim2, Oh Young Bang1
1From the Department of Radiology, Severance Stroke Center, Severance Hospital (Y.C., B.M.K., D.J.K.), Department of Neurology, Severance Stroke Center, Severance Hospital (J.H.H., H.S.N., Y.D.K), and Department of Neurology, Gangnam Severance Hospital (K.-Y.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (O.Y.B.) and Department of Radiology (P.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Neurology, National Medical Center, Seoul, South Korea (J.-H.B.); Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea (J.Y.); Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea (S.K.B., J.R.); Department of Radiology, Gangnam Severance Hospital, Yonsei University, Seoul, South Korea (S.H.S.); Department of Radiology (H.S.K.) and Department of Neurology (B.-S.S.), Chonbuk National University Medical School and Hospital, Jeonju, South Korea; Department of Radiology, Konkuk University Medical Center and School of Medicine, Seoul, South Korea (H.G.R.); Department of Radiology, Hanyang University College of Medicine and Hospital, Seoul, Korea (Y.-J.L.); Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea (S.H.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea (C.W.R.); Department of Radiology, St.Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea (Y.-K.I.); Department of Radiology, Korea University Anam Hospital, Seoul, South Korea (B.K.); Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (H.-J.J.); Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.W.K.); Department of Radiology (J.S.B., W.J.L.) and Department of Neurology (J.-M.K.), Chung-Ang University Hospital, Seoul, South Korea; Department of Radiology, Korea University College of Medicine, Guro Hospital, Seoul, South Korea (S.S.); and Department of Neurology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, South Korea (J.J.P.).
Rescue stenting (RS) offers a promising treatment for patients experiencing mechanical thrombectomy (MT) failure. This intervention improved clinical outcomes without increasing risks of hemorrhage or mortality in MT-failed stroke patients.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Mechanical thrombectomy (MT) is a primary treatment for acute ischemic stroke.
- Effective rescue treatments for MT failure remain limited.
- Identifying optimal strategies for MT-failure patients is crucial for improving stroke outcomes.
Purpose of the Study:
- To evaluate the efficacy of rescue stenting (RS) as a treatment for patients with mechanical thrombectomy (MT) failure.
- To determine if RS improves clinical outcomes in patients who do not achieve successful recanalization with initial MT.
- To assess the safety of RS in terms of symptomatic intracranial hemorrhage and mortality.
Main Methods:
- Retrospective analysis of 16 comprehensive stroke centers from September 2010 to December 2015.
- Inclusion of patients with intracranial internal carotid artery or middle cerebral artery M1 occlusion who underwent MT failure.
- Comparison of outcomes between patients who received RS and those who did not, analyzing functional outcomes, hemorrhage, and mortality.
Main Results:
- MT failed in 148 of 591 patients (25.0%).
- Rescue stenting (RS) was performed in 48 patients, with successful recanalization in 64.6%.
- The RS group showed a significantly higher rate of good functional outcome (39.6% vs. 22.0%, P=0.031) without increased symptomatic intracranial hemorrhage or mortality.
- RS was independently associated with good outcomes (OR, 3.393; 95% CI, 1.192-9.655; P=0.022).
Conclusions:
- Rescue stenting (RS) is independently associated with improved functional outcomes in patients with mechanical thrombectomy (MT) failure.
- RS does not significantly increase the risk of symptomatic intracranial hemorrhage or mortality.
- RS should be considered as a viable treatment option for MT-failed patients with internal carotid artery or middle cerebral artery M1 occlusions.
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