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Rescue intracranial permanent stenting for refractory occlusion following thrombectomy: a propensity matched analysis.
Rescue intracranial permanent stenting for refractory occlusion following thrombectomy: a propensity matched analysis.
- Source :
- Journal of NeuroInterventional Surgery; Feb2024, Vol. 16 Issue 2, p115-123, 17p
- Publication Year :
- 2024
-
Abstract
- 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. [ABSTRACT FROM AUTHOR]
- Subjects :
- ARTERIAL occlusions
RESEARCH
CEREBRAL hemorrhage
COMBINATION drug therapy
CONFIDENCE intervals
CEREBRAL infarction
INTRACRANIAL arterial diseases
SURGICAL stents
RETROSPECTIVE studies
ACQUISITION of data
TREATMENT effectiveness
HOSPITAL mortality
THROMBECTOMY
STROKE patients
MEDICAL records
DESCRIPTIVE statistics
PLATELET aggregation inhibitors
ODDS ratio
PATIENT safety
LONGITUDINAL method
EVALUATION
Subjects
Details
- Language :
- English
- ISSN :
- 17598478
- Volume :
- 16
- Issue :
- 2
- Database :
- Complementary Index
- Journal :
- Journal of NeuroInterventional Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 175518751
- Full Text :
- https://doi.org/10.1136/jnis-2022-020012