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

Author:

Stracke Christian Paul12,Fiehler Jens2,Meyer Lukas2,Thomalla Götz3,Krause Lars Udo4,Lowens Stephan5,Rothaupt Jan5,Kim Byung Moon6,Heo Ji Hoe7,Yeo Leonard L.L.8910,Andersson Tommy8911,Kabbasch Christoph12,Dorn Franziska13,Chapot Rene1,Hanning Uta2

Affiliation:

1. Department of Intracranial Endovascular Therapy Alfried‐Krupp Krankenhaus Hospital Essen Germany

2. Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg‐Eppendorf Hamburg Germany

3. Department of Neurology University Medical Center Hamburg‐Eppendorf Hamburg Germany

4. Department of Neurology Klinikum Osnabruck Osnabruck Germany

5. Department of Radiology Klinikum Osnabruck Osnabruck Germany

6. Department of Radiology Interventional Neuroradiology Severance Stroke Center Severance Hospital Yonsei University College of Medicine Seoul South Korea

7. Department of Neurology Severance Stroke Center Severance Hospital Yonsei University College of Medicine Seoul South Korea

8. Department of Neuroradiology Karolinska University Hospital Stockholm Sweden

9. Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden

10. Division of Neurology Department of Medicine National University Health System Singapore

11. Department Medical Imaging AZ Groeninge Kortrijk Belgium

12. Department of Neuroradiology University of Cologne Germany

13. Department of Neuroradiology University Hospital of Munich Germany

Abstract

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; P= 0.002), a higher premorbid modified Rankin Scale (adjusted odds ratio, 2.02; P =0.049), and a modified Thrombolysis in Cerebral Infarction score of 0 to 2a after stenting (adjusted odds ratio, 23.24; P <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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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