Emergency Intracranial Stenting in Acute Stroke: Predictors for Poor Outcome and for Complications

• Published in: Journal of the American Heart Association Vol. 9; no. 5; p. e012795
• Main Authors: Stracke, Christian Paul, Fiehler, Jens, Meyer, Lukas, Thomalla, Götz, Krause, Lars Udo, Lowens, Stephan, Rothaupt, Jan, Kim, Byung Moon, Heo, Ji Hoe, Yeo, Leonard L L, Andersson, Tommy, Kabbasch, Christoph, Dorn, Franziska, Chapot, Rene, Hanning, Uta
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 03.03.2020; Wiley
• Subjects: Aged; Aged, 80 and over; Angioplasty - adverse effects; Angioplasty - instrumentation; Cerebral Hemorrhage - etiology; Emergencies; Female; Functional Status; Humans; intracranial stenosis; Male; Medicin och hälsovetenskap; Middle Aged; Original Research; retriever; Retrospective Studies; Risk Factors; stenting; Stents; Stroke - diagnosis; Stroke - physiopathology; Stroke - therapy; thrombectomy; Thrombectomy - adverse effects; Thrombectomy - instrumentation; thrombus; Time Factors; Treatment Outcome; intracranial stenosis; retriever; thrombus; thrombectomy; stenting
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/jaha.119.012795

Background Stent-retriever thrombectomy is the first-line therapy in acute stroke with intracranial large vessel occlusion. In case of failure of stent-retriever thrombectomy, rescue stent angioplasty might be the only treatment option to achieve permanent recanalization. This study aims at identifying predictors for poor outcome and complications in a large, multicenter cohort receiving rescue stent angioplasty. Methods and Results We performed a retrospective analysis of patients with large vessel occlusion who were treated with rescue stent angioplasty after stent-retriever thrombectomy between 2012 and 2018 in 7 neurovascular centers. We defined 2 binary outcomes: (1) functional clinical outcome (good modified Rankin Scale, 0-2; and poor modified Rankin Scale, 4-6) and (2) early symptomatic intracerebral hemorrhage. Impacts of clinical, radiological, and interventional parameters on outcomewere assessed in uni- and multivariable logistic regression models. Two hundred ten patients were included with target vessels located within the anterior circulation (136 of 210; 64.8%) and posterior circulation (74 of 210; 35.2%). Symptomatic intracerebral hemorrhage occured in 22 patients, 86.4% (19 of 22) after anterior and 13.6% (3 of 22) after posterior circulation large vessel occlusion. Good functional outcome was observed in 44.8% (73 of 163). A higher National Institutes of Health Stroke Scale on admission (adjusted odds ratio, 1.10; 0.002), a higher premorbid modified Rankin Scale (adjusted odds ratio, 2.02; =0.049), and a modified Thrombolysis in Cerebral Infarction score of 0 to 2a after stenting (adjusted odds ratio, 23.24; <0.001) were independent predictors of poor functional outcome. Conclusions Use of rescue stent angioplasty can be considered for acute intracranial large vessel occlusion in cases after unsuccessful stent-retriever thrombectomy. Likelihood of symptomatic intracerebral hemorrhage is higher in anterior circulation stroke.