Rescue stenting for failed mechanical thrombectomy in acute ischemic stroke a multicenter experience

Yoonkyung Chang, Byung Moon Kim, Oh Young Bang, Jang Hyun Baek, Ji Hoe Heo, Hyo Suk Nam, Young Dae Kim, Joonsang Yoo, Dong Joon Kim, Pyoung Jeon, Seung Kug Baik, Sang Hyun Suh, Kyung Yul Lee, Hyo Sung Kwak, Hong Gee Roh, Young Jun Lee, Sang Heum Kim, Chang Woo Ryu, Yon Kwon Ihn, Byungjun KimHong Jun Jeon, Jin Woo Kim, Jun Soo Byun, Sang-Il Suh, Jeong Jin Park, Woong Jae Lee, Jieun Roh, Byoung Soo Shin, Jeong Min Kim

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background and Purpose-Effective rescue treatment has not yet been suggested in patients with mechanical thrombectomy (MT) failure. This study aimed to test whether rescue stenting (RS) improved clinical outcomes in MT-failed patients. Methods-This is a retrospective analysis of the cohorts of the 16 comprehensive stroke centers between September 2010 and December 2015. We identifed the patients who underwent MT but failed to recanalize intracranial internal carotid artery or middle cerebral artery M1 occlusion. Patients were dichotomized into 2 groups: patients with RS and without RS after MT failure. Clinical and laboratory fndings and outcomes were compared between the 2 groups. It was tested whether RS is associated with functional outcome. Results-MT failed in 148 (25.0%) of the 591 patients with internal carotid artery or middle cerebral artery M1 occlusion. Of these 148 patients, 48 received RS (RS group) and 100 were left without further treatment (no stenting group). Recanalization was successful in 64.6% (31 of 48 patients) of RS group. Compared with no stenting group, RS group showed a signifcantly higher rate of good outcome (modifed Rankin Scale score, 0-2; 39.6% versus 22.0%; P=0.031) without increasing symptomatic intracranial hemorrhage (16.7% versus 20.0%; P=0.823) or mortality (12.5% versus 19.0%; P=0.360). Of the RS group, patients who had recanalization success had 54.8% of good outcome, which is comparable to that (55.4%) of recanalization success group with MT. RS remained independently associated with good outcome after adjustment of other factors (odds ratio, 3.393; 95% confdence interval, 1.192-9.655; P=0.022). Follow-up vascular imaging was available in the 23 (74.2%) of 31 patients with recanalization success with RS. The stent was patent in 20 (87.0%) of the 23 patients. Glycoprotein IIb/IIIa inhibitor was signifcantly associated with stent patency but not with symptomatic intracranial hemorrhage. Conclusions-RS was independently associated with good outcomes without increasing symptomatic intracranial hemorrhage or mortality. RS seemed considered in MT-failed internal carotid artery or middle cerebral artery M1 occlusion.

Original languageEnglish
Pages (from-to)958-964
Number of pages7
JournalStroke
Volume49
Issue number4
DOIs
Publication statusPublished - 2018 Apr 1

Fingerprint

Thrombectomy
Stroke
Intracranial Hemorrhages
Middle Cerebral Artery Infarction
Internal Carotid Artery
Stents
Platelet Glycoprotein GPIIb-IIIa Complex
Mortality
Blood Vessels
Cohort Studies
Odds Ratio

Keywords

  • Middle cerebral artery
  • Stents
  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Chang, Y., Kim, B. M., Bang, O. Y., Baek, J. H., Heo, J. H., Nam, H. S., ... Kim, J. M. (2018). Rescue stenting for failed mechanical thrombectomy in acute ischemic stroke a multicenter experience. Stroke, 49(4), 958-964. https://doi.org/10.1161/STROKEAHA.117.020072

Rescue stenting for failed mechanical thrombectomy in acute ischemic stroke a multicenter experience. / Chang, Yoonkyung; Kim, Byung Moon; Bang, Oh Young; Baek, Jang Hyun; Heo, Ji Hoe; Nam, Hyo Suk; Kim, Young Dae; Yoo, Joonsang; Kim, Dong Joon; Jeon, Pyoung; Baik, Seung Kug; Suh, Sang Hyun; Lee, Kyung Yul; Kwak, Hyo Sung; Roh, Hong Gee; Lee, Young Jun; Kim, Sang Heum; Ryu, Chang Woo; Ihn, Yon Kwon; Kim, Byungjun; Jeon, Hong Jun; Kim, Jin Woo; Byun, Jun Soo; Suh, Sang-Il; Park, Jeong Jin; Lee, Woong Jae; Roh, Jieun; Shin, Byoung Soo; Kim, Jeong Min.

In: Stroke, Vol. 49, No. 4, 01.04.2018, p. 958-964.

Research output: Contribution to journalArticle

Chang, Y, Kim, BM, Bang, OY, Baek, JH, Heo, JH, Nam, HS, Kim, YD, Yoo, J, Kim, DJ, Jeon, P, Baik, SK, Suh, SH, Lee, KY, Kwak, HS, Roh, HG, Lee, YJ, Kim, SH, Ryu, CW, Ihn, YK, Kim, B, Jeon, HJ, Kim, JW, Byun, JS, Suh, S-I, Park, JJ, Lee, WJ, Roh, J, Shin, BS & Kim, JM 2018, 'Rescue stenting for failed mechanical thrombectomy in acute ischemic stroke a multicenter experience', Stroke, vol. 49, no. 4, pp. 958-964. https://doi.org/10.1161/STROKEAHA.117.020072
Chang, Yoonkyung ; Kim, Byung Moon ; Bang, Oh Young ; Baek, Jang Hyun ; Heo, Ji Hoe ; Nam, Hyo Suk ; Kim, Young Dae ; Yoo, Joonsang ; Kim, Dong Joon ; Jeon, Pyoung ; Baik, Seung Kug ; Suh, Sang Hyun ; Lee, Kyung Yul ; Kwak, Hyo Sung ; Roh, Hong Gee ; Lee, Young Jun ; Kim, Sang Heum ; Ryu, Chang Woo ; Ihn, Yon Kwon ; Kim, Byungjun ; Jeon, Hong Jun ; Kim, Jin Woo ; Byun, Jun Soo ; Suh, Sang-Il ; Park, Jeong Jin ; Lee, Woong Jae ; Roh, Jieun ; Shin, Byoung Soo ; Kim, Jeong Min. / Rescue stenting for failed mechanical thrombectomy in acute ischemic stroke a multicenter experience. In: Stroke. 2018 ; Vol. 49, No. 4. pp. 958-964.
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abstract = "Background and Purpose-Effective rescue treatment has not yet been suggested in patients with mechanical thrombectomy (MT) failure. This study aimed to test whether rescue stenting (RS) improved clinical outcomes in MT-failed patients. Methods-This is a retrospective analysis of the cohorts of the 16 comprehensive stroke centers between September 2010 and December 2015. We identifed the patients who underwent MT but failed to recanalize intracranial internal carotid artery or middle cerebral artery M1 occlusion. Patients were dichotomized into 2 groups: patients with RS and without RS after MT failure. Clinical and laboratory fndings and outcomes were compared between the 2 groups. It was tested whether RS is associated with functional outcome. Results-MT failed in 148 (25.0{\%}) of the 591 patients with internal carotid artery or middle cerebral artery M1 occlusion. Of these 148 patients, 48 received RS (RS group) and 100 were left without further treatment (no stenting group). Recanalization was successful in 64.6{\%} (31 of 48 patients) of RS group. Compared with no stenting group, RS group showed a signifcantly higher rate of good outcome (modifed Rankin Scale score, 0-2; 39.6{\%} versus 22.0{\%}; P=0.031) without increasing symptomatic intracranial hemorrhage (16.7{\%} versus 20.0{\%}; P=0.823) or mortality (12.5{\%} versus 19.0{\%}; P=0.360). Of the RS group, patients who had recanalization success had 54.8{\%} of good outcome, which is comparable to that (55.4{\%}) of recanalization success group with MT. RS remained independently associated with good outcome after adjustment of other factors (odds ratio, 3.393; 95{\%} confdence interval, 1.192-9.655; P=0.022). Follow-up vascular imaging was available in the 23 (74.2{\%}) of 31 patients with recanalization success with RS. The stent was patent in 20 (87.0{\%}) of the 23 patients. Glycoprotein IIb/IIIa inhibitor was signifcantly associated with stent patency but not with symptomatic intracranial hemorrhage. Conclusions-RS was independently associated with good outcomes without increasing symptomatic intracranial hemorrhage or mortality. RS seemed considered in MT-failed internal carotid artery or middle cerebral artery M1 occlusion.",
keywords = "Middle cerebral artery, Stents, Stroke, Thrombectomy",
author = "Yoonkyung Chang and Kim, {Byung Moon} and Bang, {Oh Young} and Baek, {Jang Hyun} and Heo, {Ji Hoe} and Nam, {Hyo Suk} and Kim, {Young Dae} and Joonsang Yoo and Kim, {Dong Joon} and Pyoung Jeon and Baik, {Seung Kug} and Suh, {Sang Hyun} and Lee, {Kyung Yul} and Kwak, {Hyo Sung} and Roh, {Hong Gee} and Lee, {Young Jun} and Kim, {Sang Heum} and Ryu, {Chang Woo} and Ihn, {Yon Kwon} and Byungjun Kim and Jeon, {Hong Jun} and Kim, {Jin Woo} and Byun, {Jun Soo} and Sang-Il Suh and Park, {Jeong Jin} and Lee, {Woong Jae} and Jieun Roh and Shin, {Byoung Soo} and Kim, {Jeong Min}",
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T1 - Rescue stenting for failed mechanical thrombectomy in acute ischemic stroke a multicenter experience

AU - Chang, Yoonkyung

AU - Kim, Byung Moon

AU - Bang, Oh Young

AU - Baek, Jang Hyun

AU - Heo, Ji Hoe

AU - Nam, Hyo Suk

AU - Kim, Young Dae

AU - Yoo, Joonsang

AU - Kim, Dong Joon

AU - Jeon, Pyoung

AU - Baik, Seung Kug

AU - Suh, Sang Hyun

AU - Lee, Kyung Yul

AU - Kwak, Hyo Sung

AU - Roh, Hong Gee

AU - Lee, Young Jun

AU - Kim, Sang Heum

AU - Ryu, Chang Woo

AU - Ihn, Yon Kwon

AU - Kim, Byungjun

AU - Jeon, Hong Jun

AU - Kim, Jin Woo

AU - Byun, Jun Soo

AU - Suh, Sang-Il

AU - Park, Jeong Jin

AU - Lee, Woong Jae

AU - Roh, Jieun

AU - Shin, Byoung Soo

AU - Kim, Jeong Min

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background and Purpose-Effective rescue treatment has not yet been suggested in patients with mechanical thrombectomy (MT) failure. This study aimed to test whether rescue stenting (RS) improved clinical outcomes in MT-failed patients. Methods-This is a retrospective analysis of the cohorts of the 16 comprehensive stroke centers between September 2010 and December 2015. We identifed the patients who underwent MT but failed to recanalize intracranial internal carotid artery or middle cerebral artery M1 occlusion. Patients were dichotomized into 2 groups: patients with RS and without RS after MT failure. Clinical and laboratory fndings and outcomes were compared between the 2 groups. It was tested whether RS is associated with functional outcome. Results-MT failed in 148 (25.0%) of the 591 patients with internal carotid artery or middle cerebral artery M1 occlusion. Of these 148 patients, 48 received RS (RS group) and 100 were left without further treatment (no stenting group). Recanalization was successful in 64.6% (31 of 48 patients) of RS group. Compared with no stenting group, RS group showed a signifcantly higher rate of good outcome (modifed Rankin Scale score, 0-2; 39.6% versus 22.0%; P=0.031) without increasing symptomatic intracranial hemorrhage (16.7% versus 20.0%; P=0.823) or mortality (12.5% versus 19.0%; P=0.360). Of the RS group, patients who had recanalization success had 54.8% of good outcome, which is comparable to that (55.4%) of recanalization success group with MT. RS remained independently associated with good outcome after adjustment of other factors (odds ratio, 3.393; 95% confdence interval, 1.192-9.655; P=0.022). Follow-up vascular imaging was available in the 23 (74.2%) of 31 patients with recanalization success with RS. The stent was patent in 20 (87.0%) of the 23 patients. Glycoprotein IIb/IIIa inhibitor was signifcantly associated with stent patency but not with symptomatic intracranial hemorrhage. Conclusions-RS was independently associated with good outcomes without increasing symptomatic intracranial hemorrhage or mortality. RS seemed considered in MT-failed internal carotid artery or middle cerebral artery M1 occlusion.

AB - Background and Purpose-Effective rescue treatment has not yet been suggested in patients with mechanical thrombectomy (MT) failure. This study aimed to test whether rescue stenting (RS) improved clinical outcomes in MT-failed patients. Methods-This is a retrospective analysis of the cohorts of the 16 comprehensive stroke centers between September 2010 and December 2015. We identifed the patients who underwent MT but failed to recanalize intracranial internal carotid artery or middle cerebral artery M1 occlusion. Patients were dichotomized into 2 groups: patients with RS and without RS after MT failure. Clinical and laboratory fndings and outcomes were compared between the 2 groups. It was tested whether RS is associated with functional outcome. Results-MT failed in 148 (25.0%) of the 591 patients with internal carotid artery or middle cerebral artery M1 occlusion. Of these 148 patients, 48 received RS (RS group) and 100 were left without further treatment (no stenting group). Recanalization was successful in 64.6% (31 of 48 patients) of RS group. Compared with no stenting group, RS group showed a signifcantly higher rate of good outcome (modifed Rankin Scale score, 0-2; 39.6% versus 22.0%; P=0.031) without increasing symptomatic intracranial hemorrhage (16.7% versus 20.0%; P=0.823) or mortality (12.5% versus 19.0%; P=0.360). Of the RS group, patients who had recanalization success had 54.8% of good outcome, which is comparable to that (55.4%) of recanalization success group with MT. RS remained independently associated with good outcome after adjustment of other factors (odds ratio, 3.393; 95% confdence interval, 1.192-9.655; P=0.022). Follow-up vascular imaging was available in the 23 (74.2%) of 31 patients with recanalization success with RS. The stent was patent in 20 (87.0%) of the 23 patients. Glycoprotein IIb/IIIa inhibitor was signifcantly associated with stent patency but not with symptomatic intracranial hemorrhage. Conclusions-RS was independently associated with good outcomes without increasing symptomatic intracranial hemorrhage or mortality. RS seemed considered in MT-failed internal carotid artery or middle cerebral artery M1 occlusion.

KW - Middle cerebral artery

KW - Stents

KW - Stroke

KW - Thrombectomy

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