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Use of intracranial stent as rescue therapy after mechanical thrombectomy failure—9-year experience in a comprehensive stroke centre

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

There is no established rescue treatment in patients with mechanical thrombectomy (MT) failure. Our aim is to analyse whether the use of an intracranial stent improves prognosis in these patients.

Methods

Retrospective analysis of a prospective cohort of patients with ischemic stroke due to middle cerebral artery occlusion (MCA) or distal intracranial carotid artery (ICA) occlusion, from September 2009 to April 2019 in our comprehensive stroke care centre. Patients with MT failure were identified and dichotomized into two groups according to whether or not an intracranial stent was implanted. We analysed clinical outcomes in both groups.

Results

There was MT failure in 60 patients (14%) of the 433 with large vessel occlusion in distal ICA and proximal MCA. A stent was placed in 20 of them (33.3%). Compared to patients without rescue stenting, they showed better rates of independence at 3 months (mRS ≤ 2) 45% vs 2.5% (p < 0.001) and lower mortality 15% vs 50% (p = 0.009), maintaining statistical significance after multivariate analysis, without a significant increase of the rate of symptomatic intracranial haemorrhage (p = 0.209).

Conclusion

Placement of an intracranial stent as rescue therapy after MT failure was associated with better clinical outcome without significant increase in haemorrhagic complications. We believe that this procedure should be appraised in these patients.

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Abbreviations

EVT:

Endovascular treatment

LVO:

Large vessel occlusion

mTICI:

Modified thrombolysis in cerebral ischemia

ICA:

Internal carotid artery

MCA:

Middle cerebral artery

ICAS:

Intracranial atherosclerotic stenosis

NIHSS:

National Institutes of Health Stroke Scale

mRS:

Modified Rankin Scale

tPA:

Tissue plasminogen activator

GPI:

Glycoprotein IIb/IIIa inhibitor

SG:

Stenting group

NSG:

Non-stenting group

sICH:

Symptomatic intracranial haemorrhage

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Interventional Neuroradiology, Hospital Clínico San Carlos, Calle del Prof Martín Lagos s/n, 28040, Madrid, Spain

    C. Pérez-García, S. Rosati, L. López-Ibor & M. Moreu

  2. Neurology, Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040, Madrid, Spain

    C. Gómez-Escalonilla, J. A. Egido & P. Simal

Authors
  1. C. Pérez-García
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  2. C. Gómez-Escalonilla
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  3. S. Rosati
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  4. L. López-Ibor
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  5. J. A. Egido
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  6. P. Simal
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  7. M. Moreu
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Correspondence to C. Pérez-García.

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Conflict of interests

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Patient consent

Regarding the patients’ consent, all images were completely anonymized and the exact patients’ genders and ages are not shown (nor in the manuscript nor in the demographics table). In our centre, we carry out a large number of mechanical thrombectomies on a very extensive population. Although we perform a clinical control at least 3 months after the procedure, there are many patients who over the years have lost their contact. These circumstances, together with the fact that 22 of the 60 patients died in the first 3 months after the procedure, do not allow informed consent to be obtained.

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Pérez-García, C., Gómez-Escalonilla, C., Rosati, S. et al. Use of intracranial stent as rescue therapy after mechanical thrombectomy failure—9-year experience in a comprehensive stroke centre. Neuroradiology 62, 1475–1483 (2020). https://doi.org/10.1007/s00234-020-02487-9

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  • DOI: https://doi.org/10.1007/s00234-020-02487-9

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