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Published on: May 14, 2013
Long-Term Outcome of Rescue Stenting for Acute Intracranial Atherosclerotic Stenosis-Related Large Vessel Occlusion
Hyungjong Park1, Byung Moon Kim2, Jun-Whee Kim3
1From the Department of Neurology (H.P.), Keimyung University School of Medicine, Daegu, Korea.
Insights
Rescue stenting after failed mechanical thrombectomy for intracranial atherosclerotic stenosis large vessel occlusion demonstrates low long-term stroke recurrence and durable stent patency. This study evaluates long-term outcomes of rescue stents in stroke patients.
Area of Science:
- Neuroendovascular therapy
- Cerebrovascular diseases
- Interventional neurology
Background:
- Mechanical thrombectomy (MT) is a primary treatment for acute ischemic stroke due to large vessel occlusion (LVO).
- Intracranial atherosclerotic stenosis (ICAS) is a common cause of LVO, often requiring rescue stenting (RS) after failed MT.
- Long-term outcomes (≥12 months) of RS following MT failure for ICAS-LVO remain underexplored.
Purpose of the Study:
- To evaluate the long-term clinical outcomes and safety of rescue stenting (RS) in patients with intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion (LVO).
- To assess functional outcomes (modified Rankin Scale 0-2), mortality, stroke recurrence, symptomatic intracranial hemorrhage (SICH), and stent patency.
- To elucidate the durability of rescue stents in the long term.
Main Methods:
- Retrospective analysis of 154 patients who received RS for ICAS-LVO after failed MT.
- Data sourced from a prospectively maintained multicenter database.
- Assessment of outcomes including good outcome (mRS 0-2), mortality, stroke recurrence, SICH, and stent patency at various follow-up intervals (3 months and ≥12 months).
Main Results:
- Successful recanalization was achieved in 85.7% (132/154) of patients post-RS.
- Good functional outcome (mRS 0-2) was observed in 53.2% (67/126) at long-term follow-up (median 33 months).
- Low long-term stroke recurrence (3.2%) and a high final stent patency rate (96.7%) were noted, with durable patency observed in stents patent at initial follow-up.
Conclusions:
- Rescue stenting for ICAS-LVO after failed MT is associated with favorable long-term outcomes.
- Patients demonstrate a low rate of stroke recurrence and sustained stent patency over time.
- The durability of rescue stents is promising, particularly for those patent in the initial follow-up period.
Background And Purpose:
Rescue stent (RS) is an accepted rescue option after failed mechanical thrombectomy (MT) for acute ischemic stroke due to intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion (LVO). However, the long-term outcomes (≥12 months) of RS have not yet been elucidated.
Materials And Methods:
We retrospectively analyzed the data of 154 patients with RS for ICAS-related LVO, which were identified from a prospectively maintained multicenter database of RS after MT failure, to assess good outcome (mRS 0-2), mortality, stroke recurrence, symptomatic intracranial hemorrhage (SICH), and stent patency.
Results:
Among 154 patients, successful recanalization was achieved in 132 (85.7%) after RS. Clinical follow-up was available in 148 patients at 3 months, of whom 126 were followed longer than 12 months. Good outcome was observed in 53.4% (79/148) at 3 months and 53.2% (67/126) at the final assessment among survivors (median, 33; interquartile range [IQR], 13-91 months). The overall incidence of mortality was 16.2% (24/148). Mortality occurred in 8.8% (13/148) of patients at 3 months and 8.7% (11/126) thereafter, respectively. Stroke recurrence was 0.7% (1/148) within 3 months and 3.2% (4/126) thereafter. The overall incidence of SICH was 9.5% (14/148). SICH occurred in 8.8% (13/148) within the first 3 months and in 0.8% (1/126) thereafter. The stented vessel was patent in 81.1% (99/122) at the first follow-up (median, 3; IQR, 1-125 months) and 96.7% (89/92) at the final follow-up (median, 18; IQR, 13-68 months).
Conclusions:
Patients with RS for ICAS-LVO showed a low stroke recurrence rate in the long-term. The long-term patency of RS appears to remain durable, particularly when it remained patent during the initial follow-up.
