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Author Spotlight: Innovative Techniques and Future Directions in Stroke Research
Published on: May 5, 2023
Prevalence and Angiographic Outcomes of Rescue Intracranial Stenting in Large Vessel Occlusion Following Stroke
Hamidreza Saber1, Michael T Froehler2, Osama O Zaidat3
1Departments of Neurology and Neurosurgery Dell Medical School University of Texas at Austin Austin TX.
Insights
Intracranial rescue stenting in large vessel occlusion stroke due to intracranial atherosclerosis (ICAD-LVO) is uncommon but effective. This intervention achieved successful reperfusion with no symptomatic hemorrhage in ICAD-LVO patients.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Large vessel occlusion (LVO) stroke secondary to intracranial atherosclerotic disease (ICAD-LVO) affects 7-30% of patients.
- Significant variability exists in the utilization of intracranial rescue stenting.
- This study characterizes the frequency and outcomes of intracranial rescue stenting in ICAD-LVO.
Purpose of the Study:
- To determine the frequency and characteristics of intracranial rescue stenting in patients undergoing endovascular therapy for LVO stroke.
- To evaluate the outcomes of intracranial rescue stenting, specifically reperfusion rates and intracranial hemorrhage, in patients with ICAD-LVO.
Main Methods:
- Analysis of data from the Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke (STRATIS) registry.
- Adjudication of occlusion location, use of angioplasty/stenting, and imaging outcomes by a core lab.
- Categorization of stroke etiology and statistical analysis of rescue stenting's impact on reperfusion and hemorrhage in ICAD-LVO.
Main Results:
- Of 978 LVO stroke patients, 91 (9.3%) had ICAD-LVO.
- Successful reperfusion was lower in ICAD-LVO (74.2%) compared to cardioembolic LVO (87.5%).
- Intracranial rescue stenting was used in 7.1% of ICAD-LVO cases, achieving successful reperfusion in all instances with 0% symptomatic intracranial hemorrhage.
Conclusions:
- Intracranial rescue stenting in ICAD-LVO is associated with favorable angiographic outcomes.
- Rescue stenting in ICAD-LVO demonstrated low rates of symptomatic intracranial hemorrhage.
- The findings support the consideration of acute intracranial stenting as a rescue therapy in ICAD-LVO.
Background:
Large vessel occlusion secondary to underlying intracranial atherosclerotic disease (ICAD-LVO) has an estimated prevalence of 7% to30%. There is a large variation in the use of intracranial rescue stenting in interventional practice. We aimed to characterize the frequency and characteristics of intracranial rescue stenting in a large cohort of endovascular therapy for stroke.
Methods:
The Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke (STRATIS) angiography core lab adjudicated the location of the occlusion, hyperdense vessel sign on initial imaging, the use of angioplasty and stenting, and imaging outcomes following endovascular therapy. Underlying cause of stroke was categorized into intracranial atherosclerosis, cardioembolic, and other subtypes. Statistical analyses examined the relationship between intracranial rescue stenting and imaging outcomes including intracranial hemorrhage, and arterial reperfusion using expanded Thrombolysis in Cerebral Infarction reperfusion score in patients with ICAD-LVO.
Results:
Among 978 patients with LVO stroke undergoing endovascular therapy, 91 (9.3%) patients had ICAD-LVO. Baseline hyperdense vessel sign was observed among 44 (62.7%) with ICAD versus 178 (68.2%) with cardioembolic LVO (P = 0.4). Final successful reperfusion (expanded Thrombolysis in Cerebral Infarction 2b50 or more) was significantly lower among ICAD-LVO as compared with cardioembolic-LVO (74.2% versus 87.5%; P = 0.007). Intracranial rescue stenting was used among 14/665 (2.1%) of patients with LVO (5 ICA terminus, 7 M1 middle cerebral artery, 1 M2 middle cerebral artery, 1 proximal basilar artery). Among 14 intracranial rescue stenting cases, 5/70 (7.1%) belonged to the ICAD group, 3/261 (1.1%) cardioembolic group, and 6/334 (1.8%) in other or undetermined group. Successful reperfusion following rescue stenting was achieved in all cases with ICAD-LVO. Among ICAD-LVO, the rate of 24 hours symptomatic intracranial hemorrhage was 0% with acute intracranial stenting versus 7.7% in the nonstenting subgroup.
Conclusion:
In STRATIS, nearly 1 of every 11 thrombectomies were performed in patients with underlying ICAD, among whom 7.1% underwent rescue intracranial stenting concomitant with thrombectomy. Acute intracranial stenting as rescue therapy in ICAD-LVO was associated with favorable angiographic outcomes and low symptomatic hemorrhage rates.
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