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

Stracke, Christian Paul; Fiehler, Jens; Meyer, Lukas; Thomalla, Goetz; Krause, Lars Udo; Lowens, Stephan; Rothaupt, Jan; Kim, Byung Moon; Heo, Ji Hoe; Yeo, Leonard L. L.; Andersson, Tommy; Kabbasch, Christoph; Dorn, Franziska; Chapot, Rene und Hanning, Uta (2020): Emergency Intracranial Stenting in Acute Stroke: Predictors for Poor Outcome and for Complications. In: Journal of the American Heart Association, Bd. 9, Nr. 5

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.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 2047-9980
• Sprache: Englisch