Emergency Intracranial Stenting in Acute Stroke: Predictors for Good Outcome and for Complications
Stracke, Paul (2019), Emergency Intracranial Stenting in Acute Stroke: Predictors for Good Outcome and for Complications, Dryad, Dataset, https://doi.org/10.15146/r2qr-1b50
Background: Stent-retriever thrombectomy (SRT) is the first-line therapy in acute stroke with intracranial large vessel occlusion (LVO). However, SRT may fail in patients with intracranial atherosclerotic stenosis or dissection, where rescue stent angioplasty (RSA) may be the only treatment option to achieve permanent recanalization.
Purpose: This study aims at identifying predictors for good outcome and for complications in a large multicenter cohort of these patients.
Methods: We performed a retrospective analysis of patients with LVO who were treated with RSA after SRT between 2012 and 2018 in seven neurovascular centers. We defined two binary outcomes (yes/no): 1) functional clinical outcome after 90 days (good (modified Rankin Scale (mRS) 0-2) and poor (mRS 4-6)) and 2) symptomatic intracerebral hemorrhage (sICH) in the immediate post-interventional phase. The impacts of clinical, radiological and interventional parameters on outcome were analysed.
Results: 210 patients out of 4751 thrombectomies (4.4%) were included with 136 (64.8%) anterior circulation and 74 (35.2%) patients with posterior circulation LVO. In 22 patients sICH occured, 19 (86.4%) after anterior and 3 (13.6%) after posterior circulation LVO. After 3 months 73 /163 (44.8%) patients had a good clinical outcome. A higher NIHSS at admission (adjusted OR, 1.10, P=0.002), a higher premorbid mRS (adjusted OR, 2.02, P =0.049) and a mTICI (modified thrombolysis in cerebral infarction) score of 0-2a in the final run after stenting (adjusted OR, 23.24 per maneuvre, P <0.001) were independent predictors of poor functional outcome.
Conclusions: The use of RSA can be considered for acute intracranial LVO in cases after unsuccessful SRT. The likelihood of sICH is higher in anterior circulation stroke.