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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.

Authors :
Ifergan, Heloise
Dargazanli, Cyril
Hassen, Wagih Ben
Hak, Jean-Francois
Gory, Benjamin
Ognard, Julien
Premat, Kevin
Marnat, Gaultier
Kerleroux, Basile
Zhu, François
Bellanger, Guillaume
Sporns, Peter B.
Charbonnier, Guillaume
Forestier, Géraud
Caroff, Jildaz
Fauché, Cédric
Clarençon, Frédéric
Janot, Kevin
Lapergue, Bertrand
Boulouis, Gregoire
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]

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