Stenting as a Rescue Treatment for Anterior Circulation Large Artery Occlusion

Study Questions:

What are the outcomes among patients with permanent stenting and those without stenting after stentriever failure?

Methods:

The investigators retrospectively evaluated 208 patients who underwent stentriever thrombectomy for anterior circulation large artery occlusion between September 2010 and September 2015. Modified thrombolysis in cerebral ischemia 2b-3 recanalization was achieved with stentriever alone or in combination with the Penumbra device in 155 patients (74.5%). An additional eight patients (3.8%) obtained modified thrombolysis in cerebral ischemia 2b-3 with urokinase or glycoprotein IIb/IIIa inhibitor infusion. Of the remaining 45 patients (21.6%), 17 underwent stenting (stenting group; mean age, 68 years), whereas 28 did not undergo stenting (nonstenting group; mean age, 72 years). The rate of modified thrombolysis in cerebral ischemia 2b-3 in the stenting group was assessed, and clinical outcomes were compared between groups.

Results:

There were no differences in clinical and laboratory findings, initial National Institutes of Health Stroke Scale score, location of anterior circulation large artery occlusion, and onset-to-puncture time between groups. Modified thrombolysis in cerebral ischemia 2b-3 was achieved in 14 members (83.3%) of the stenting group. The stenting group had more favorable outcomes (modified Rankin Scale score 0–2, 35.3%) and less cerebral herniation (11.8%) than the nonstenting group (modified Rankin Scale score 0–2, 7.1%; cerebral herniation, 42.9%; p < 0.05 for both). Symptomatic intracranial hemorrhage and mortality rates did not differ between the stenting group (symptomatic intracranial hemorrhage, 11.8%; mortality, 23.5%) and the nonstenting group (symptomatic intracranial hemorrhage, 14.3%; mortality, 39.3%).

Conclusions:

The authors concluded that permanent stenting may be a rescue modality for stentriever-failed anterior circulation large artery occlusion.

Perspective:

This small pilot study reports that, in patients with acute anterior circulation large artery occlusion that was refractory to stentriever thrombectomy, permanent stenting achieved recanalization in most cases, and the stent group had a significantly higher favorable outcome rate than the nonstent group without an increase in symptomatic intracranial hemorrhage or mortality. This appears to suggest that permanent stenting may be a rescue treatment modality for stentriever failed acute anterior circulation large artery occlusion. Additional larger prospective studies are indicated to confirm these findings.

Clinical Topics: Cardiac Surgery, Clinical Topic Collection: Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Lipid Metabolism, Novel Agents, Interventions and Vascular Medicine

Keywords: Brain Ischemia, Cerebral Infarction, Coronary Occlusion, Intracranial Hemorrhages, Ischemia, Platelet Glycoprotein GPIIb-IIIa Complex, Stents, Stroke, Thrombectomy, Urokinase-Type Plasminogen Activator, Vascular Diseases


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