Rescue stenting for acute ischemic stroke with refractory emergent large vessel occlusion in the modern thrombectomy era

Ahmad Sweid, Kalyan C. Sajja, Nikolaos Mouchtouris, Joshua H. Weinberg, Kavya Shivashankar, Hassan Saad, Rawad Abbas, Kareem El Naamani, Sunidhi Ramesh, Joseph Schaefer, Fadi Al Saiegh, Pascal Jabbour, Nabeel A. Herial, Hekmat Zarzour, Stavropoula Tjoumakaris, Victor Romo, Robert H. Rosenwasser, M. Reid Gooch

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background and purpose: Rescue stenting is used as a bailout technique during mechanical thrombectomy for stroke. We performed a retrospective study analyzing outcomes of patients that received a stent as a bailout measure and compared results to a control group. Methods: We identified all patients who underwent a mechanical thrombectomy for a large vessel occlusion between January 2010 and October 2019. Subjects with mTICI 0–2 A after at least three passes were defined as failed MT and constituted the control group (NSG-controls). Patients that received a rescue stent (RSG) formed the study group. Results: Comparative analysis of patient demographics between NSG-controls and SRG was performed. Baseline characteristics and comorbidities were not significantly different between both groups. NIHSS at admission and IV t-PA were not significantly different among both groups (16.5 vs. 14.2, p = 0.19) and (39.4% vs. 29.4%, p = 0.30), respectively. There was no significant difference in procedural and post-procedural complications between both the groups. In the RSG, 24 patients (82.4%) achieved favorable revascularization outcomes. NIHSS at discharge (p = 0.01) was higher in the NSG-controls, while favorable functional outcome at three months (12% vs. 39.2%, p = 0.01) was observed at a higher proportion in the RSG. There was also a significant mortality difference, with 15.2% mortality in the RSG compared to 35.1% mortality in the NSG-controls (p = 0.03). In multivariate analysis, stenting was an independent predictor of favorable outcome (OR: 10.0, p = 0.009). Conclusion: Herein, we demonstrated that rescue stenting is a feasible, safe, and effective procedure to improve stroke outcomes and should be seriously considered if the primary mechanical thrombectomy is not successful.

Original languageEnglish (US)
Article number107183
JournalClinical Neurology and Neurosurgery
Volume215
DOIs
StatePublished - Apr 2022
Externally publishedYes

Keywords

  • Angioplasty
  • Mechanical thrombectomy
  • Rescue stenting
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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