Rescue intracranial stenting for failed posterior circulation thrombectomy: analysis from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study

Author:

Mohammaden Mahmoud HORCID,Tarek Mohamed A,Aboul Nour HassanORCID,Haussen Diogo C,Fifi Johanna T,Matsoukas StavrosORCID,Farooqui MudassirORCID,Ortega-Gutierrez SantiagoORCID,Zevallos Cynthia BORCID,Galecio-Castillo Milagros,Hassan Ameer EORCID,Tekle WondwossenORCID,Al-Bayati Alhamza RORCID,Salem Mohamed MORCID,Burkhardt Jan Karl,Pukenas Bryan,Cortez Gustavo M,Hanel Ricardo A,Aghaebrahim AminORCID,Sauvageau Eric,Hafeez Muhammad,Kan PeterORCID,Tanweer Omar,Jumaa Mouhammad,Zaidi Syed F,Oliver Marion,Sheth Sunil A,Nahhas MichaelORCID,Salazar-Marioni Sergio,Khaldi AhmadORCID,Li Hanzhou,Kuybu Okkes,Abdalkader MohamadORCID,Klein PiersORCID,Peng Sophia,Alaraj AliORCID,Nguyen Thanh NORCID,Nogueira Raul GORCID

Abstract

BackgroundsRecent 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−).MethodsThis 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.ResultsA 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.ConclusionIn patients with posterior circulation stroke who had failed MT, RS resulted in better functional outcomes with comparable safety profile to procedure termination.

Publisher

BMJ

Subject

Neurology (clinical),General Medicine,Surgery

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