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Rescue intracranial stenting for failed posterior circulation thrombectomy: analysis from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study.
Mohammaden, Mahmoud H; Tarek, Mohamed A; Aboul Nour, Hassan; Haussen, Diogo C; Fifi, Johanna T; Matsoukas, Stavros; Farooqui, Mudassir; Ortega-Gutierrez, Santiago; Zevallos, Cynthia B; Galecio-Castillo, Milagros; Hassan, Ameer E; Tekle, Wondwossen; Al-Bayati, Alhamza R; Salem, Mohamed M; Burkhardt, Jan Karl; Pukenas, Bryan; Cortez, Gustavo M; Hanel, Ricardo A; Aghaebrahim, Amin; Sauvageau, Eric; Hafeez, Muhammad; Kan, Peter; Tanweer, Omar; Jumaa, Mouhammad; Zaidi, Syed F; Oliver, Marion; Sheth, Sunil A; Nahhas, Michael; Salazar-Marioni, Sergio; Khaldi, Ahmad; Li, Hanzhou; Kuybu, Okkes; Abdalkader, Mohamad; Klein, Piers; Peng, Sophia; Alaraj, Ali; Nguyen, Thanh N; Nogueira, Raul G.
Affiliation
  • Mohammaden MH; Neurology, South Valley University Faculty of Medicine, Qena, Egypt.
  • Tarek MA; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Aboul Nour H; Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Haussen DC; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Fifi JT; Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Matsoukas S; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Farooqui M; Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Ortega-Gutierrez S; Neurology and Neurosurgery, University of Kentucky, Lexington, Kentucky, USA.
  • Zevallos CB; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Galecio-Castillo M; Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Hassan AE; Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
  • Tekle W; Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
  • Al-Bayati AR; Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Salem MM; Neuroloy, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Burkhardt JK; Neurology, University of Iowa, Iowa City, Iowa, USA.
  • Pukenas B; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Cortez GM; Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA.
  • Hanel RA; Neurology, UTRGV School of Medicine, Harlingen, Texas, USA.
  • Aghaebrahim A; Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA.
  • Sauvageau E; Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Hafeez M; Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Kan P; Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  • Tanweer O; Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA.
  • Jumaa M; Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA.
  • Zaidi SF; Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA.
  • Oliver M; Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA.
  • Sheth SA; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
  • Nahhas M; Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.
  • Salazar-Marioni S; Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
  • Khaldi A; Neurology, University of Toledo - Health Science Campus, Toledo, Ohio, USA.
  • Li H; Neurology, University of Toledo - Health Science Campus, Toledo, Ohio, USA.
  • Kuybu O; Department of Neurology, University of Toledo - Health Science Campus, Toledo, Ohio, USA.
  • Abdalkader M; Neurology, University of Texas McGovern Medical School, Houston, Texas, USA.
  • Klein P; Department of Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA.
  • Peng S; Neurology, University of Texas McGovern Medical School, Houston, Texas, USA.
  • Alaraj A; Neurosurgery, WellStar Health System, Marietta, Georgia, USA.
  • Nguyen TN; Department of Neurosciences, WellStar Health System, Marietta, Georgia, USA.
  • Nogueira RG; Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
J Neurointerv Surg ; 2023 Sep 12.
Article in En | MEDLINE | ID: mdl-37699704
ABSTRACT
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.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Clinical_trials / Prognostic_studies Language: En Journal: J Neurointerv Surg Year: 2023 Document type: Article Affiliation country:
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Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Clinical_trials / Prognostic_studies Language: En Journal: J Neurointerv Surg Year: 2023 Document type: Article Affiliation country: