[en] [en] BACKGROUND: Rescue intracranial stenting (RIS) can be used in refractory large vessel occlusion (LVO) after mechanical thrombectomy (MT). We aimed to assess the safety and efficacy of RIS versus a propensity matched sample of patients with persistent LVO.
METHODS: We retrospectively analysed a multicenter retrospective pooled cohort of patients with anterior LVO (2015-2021) treated with MT, and identified patients with at least three passes and a modified Thrombolysis In Cerebral Infarction (mTICI) score of 0 to 2a. Propensity score matching was used to account for determinants of outcome in patients with or without RIS. The study outcomes included 3 months modified Rankin Scale (mRS) and symptomatic hemorrhagic transformation (HT).
RESULTS: 420 patients with a refractory anterior occlusion were included, of which 101 were treated with RIS (mean age 69 years). Favorable outcome (mRS 0-2) was more frequent in patients with a patent stent at day 1 (53% vs 6%, P<0.001), which was independently associated with an early dual antiplatelet regimen (P<0.05). In the propensity matched sample, patients treated with RIS versus without RIS had similar rates of favorable outcomes (36.8% vs 30.3%, P=0.606). Patients with RIS showed a favorable shift in the overall mRS distributions (common adjusted OR 0.74, 95% CI 0.60 to 0.91, P=0.006). Symptomatic HT was marginally more frequent in the RIS group (9% vs 3%, P=0.07), and there was no difference in 3-month mortality.
CONCLUSION: In selected patients with a refractory intracranial occlusion despite at least three thrombectomy passes, RIS may be associated with an overall shift towards more favorable clinical outcome, and no significant increase in the odds of symptomatic HT or death.
Disciplines :
Neurology
Author, co-author :
Ifergan, Heloise ; Diagnostic and Interventional Neuroradiology, University Hospital of Tours, Tours, Centre, France ifergan.heloise@hotmail.fr
Dargazanli, Cyril; Diagnostic and Interventional Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
Ben Hassen, Wagih; Diagnostic and Interventional Neuroradiology, Saint Anne Hospital Centre, Paris, France
Hak, Jean-Francois ; Diagnostic and Interventional Neuroradiology, Hospital Timone, University Hospital of Marseille, Marseille, France
Gory, Benjamin; Department of Diagnostic and Therapeutic Neuroradiology, University of Lorraine, INSERM U1254, IADI, F-54000, University Hospital of Nancy, Nancy, France
Ognard, Julien ; Diagnostic and Interventional Neuroradiology, University and Regional Hospital Centre Brest, Brest, France
Premat, Kevin; Diagnostic and Interventional Neuroradiology, University Hospital of Pitié Salpêtrière, APHP, Paris, France
Marnat, Gaultier ; Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
Kerleroux, Basile ; Diagnostic and Interventional Neuroradiology, Saint Anne Hospital Centre, Paris, France
Zhu, François ; Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
Bellanger, Guillaume; Diagnostic and Interventional Neuroradiology, University Hospital of Toulouse, Toulouse, France
Sporns, Peter B ; Diagnostic and Interventional Neuroradiology, University Hospital of Basel, Basel, Switzerland
Charbonnier, Guillaume ; Diagnostic and Interventional Neuroradiology, University Hospital of Besançon, Besancon, France
Forestier, Géraud ; Diagnostic and Interventional Neuroradiology, University Hospital of Limoges, Limoges, France
Caroff, Jildaz ; Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
Fauché, Cédric; Diagnostic and Interventional Neuroradiology, University Hospital of Poitiers, Poitiers, France
Clarençon, Frédéric; Diagnostic and Interventional Neuroradiology, University Hospital of Pitié Salpêtrière, APHP, Paris, France
Janot, Kevin ; Diagnostic and Interventional Neuroradiology, University Hospital of Tours, Tours, Centre, France
Lapergue, Bertrand; Neurology, Stroke Center, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
Boulouis, Gregoire ; Diagnostic and Interventional Neuroradiology, University Hospital of Tours, Tours, Centre, France
ETIS registry collaborators and the JENI research collaborative
GM: consulting fees from Stryker, Balt and Microvention, and paid lectures from Medtronic, Johnson & Johnson, and Phenox. JC: consulting fees and paid lectures from Medtronic, Balt and Stryker. He is a member of the editorial board of the JNIS. BL: research grants from Microvention, Balt and Phénox. FC: paid to the Institution for the PHRC national for DISCOUNT and for BLITZ studies. Consulting fees from Balt, Microvention, Stryker, and Medtronic, payment from Penumbra. Paid by Artedrone board member. Stock or stock options in Intradys and Collavidence.
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