Intracranial Stenting After Failed Thrombectomy in Patients With Moderately Severe Stroke: A Multicenter Cohort Study

Meyer, Lukas; Fiehler, Jens; Thomalla, Götz; Krause, Lars Udo; Lowens, Stephan; Rothaupt, Jan; Kim, Byung Moon; Heo, Ji Hoe; Yeo, Leonard L.L.; Andersson, Tommy; Kabbasch, Christoph; Dorn, Franziska; Chapot, René; Stracke, Christian Paul; Hanning, Uta

doi:10.3389/fneur.2020.00097

Cited by 23 publications

(15 citation statements)

References 27 publications

(34 reference statements)

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“…We found that the meniscus sign was rare in the presence of underlying intracranial stenosis and is significantly associated with cardioembolic etiology, which is a known independent predictor of successful reperfusion [5]. In cohorts where the proportion of intracranial atherosclerotic stenosis is higher, such as in Asian stroke patients [15], a significant proportion of patients with large vessel occlusion and no meniscus sign will have an in situ thrombosis in an intracranial atherosclerotic plaque and/or stenosis, which may be associated with reduced efficacy of EVT [16]. Likewise, lower reperfusion rates are expected to be achieved in patients with basilar artery occlusion and no meniscus sign, because a high proportion of these patients will present a severe basilar artery stenosis, which is known to be responsible for 1/4 of basilar artery occlusion cases [17].…”

Section: Discussionmentioning

confidence: 99%

Meniscus Sign in Patients with Anterior Circulation Large Vessel Occlusion Stroke does not Predict Outcome

et al. 2022

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Purpose The angiographic appearance of the occlusion site was suggested to influence outcomes of stroke patients with large vessel occlusion (LVO) who undergo endovascular treatment (EVT). We aimed to study the impact of the meniscus sign (MS) on outcomes of stroke patients with anterior circulation LVO. Methods Based on two prospective registries of acute ischemic stroke, we selected patients with carotid‑T, M1 or M2 occlusion who underwent EVT. Clinical characteristics and outcomes were collected from the registries or from individual records. Two independent observers blinded to outcomes assessed the presence of MS in digital subtraction angiography before thrombectomy. Angiographic and clinical outcomes of patients with and without MS were compared. Results We included 903 patients, with median age of 78 years, 59.8% were male, median baseline NIHSS was 14 and 39.5% received intravenous thrombolysis. Patients with MS (n = 170, 18.8%) were more frequently female, presented with higher NIHSS scores and more frequently underwent intravenous thrombolysis. Presence of MS was significantly associated with cardioembolic etiology. Successful reperfusion, number of passes, first pass effect, procedural time, symptomatic intracerebral hemorrhage, in-hospital mortality and favorable 3‑month functional outcome were similar in the groups of patients with and without MS. In the multivariable analyses, MS was not associated with successful reperfusion (odds ratio, OR = 1.08, 95% confidence interval, CI = 0.76–1.55), first pass effect (OR = 0.96, 95%CI = 0.48–1.92) or favorable 3‑month outcome (OR = 1.40, 95%CI = 0.88–2.24). Conclusion The presence of MS in acute ischemic stroke patients with anterior circulation large vessel occlusion who undergo EVT does not appear to influence angiographic or clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Meniscus Sign in Patients with Anterior Circulation Large Vessel Occlusion Stroke does not Predict Outcome

et al. 2022

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“…Adjusted for moderately severe stroke, early neurological improvement (ENI) was specified in a binary fashion as an improvement in NIHSS scores of at least 4 points or reaching 0 points. 21 Functional outcome was assessed with the modified Rankin Scale (mRS) score at the 90-day follow-up, with excellent functional outcome defined as an mRS score of 1 point or lower and favorable functional outcome as an mRS score of 2 points or lower. Mortality rates were assessed during hospitalization and at the 90-day follow-up.…”

Section: Clinical and Safety Outcomesmentioning

confidence: 99%

Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke

et al. 2021

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IMPORTANCE Clinical evidence of the potential treatment benefit of mechanical thrombectomy for posterior circulation distal, medium vessel occlusion (DMVO) is sparse.OBJECTIVE To investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice. DESIGN, SETTING, AND PARTICIPANTSThis multicenter case-control study analyzed patients who were treated for primary distal occlusion of the posterior cerebral artery (PCA) of the P2 or P3 segment. These patients received mechanical thrombectomy or standard medical treatment (with or without IVT) at 1 of 23 comprehensive stroke centers in Europe, the United States, and Asia between January 1, 2010, and June 30, 2020. All patients who met the inclusion criteria were matched using 1:1 propensity score matching. INTERVENTIONS Mechanical thrombectomy or standard medical treatment with or without IVT.MAIN OUTCOMES AND MEASURES Clinical end point was the improvement of National Institutes of Health Stroke Scale (NIHSS) scores at discharge from baseline. Safety end point was the occurrence of symptomatic intracranial hemorrhage and hemorrhagic complications were classified based on the Second European-Australasian Acute Stroke Study (ECASSII). Functional outcome was evaluated with the modified Rankin Scale (mRS) score at 90-day follow-up. RESULTSOf 243 patients from all participating centers who met the inclusion criteria, 184 patients were matched. Among these patients, the median (interquartile range [IQR]) age was 74 (62-81) years and 95 (51.6%) were female individuals. Posterior circulation DMVOs were located in the P2 segment of the PCA in 149 patients (81.0%) and in the P3 segment in 35 patients (19.0%). At discharge, the mean NIHSS score decrease was −2.4 points (95% CI, −3.2 to −1.6) in the standard medical treatment cohort and −3.9 points (95% CI, −5.4 to −2.5) in the mechanical thrombectomy cohort, with a mean difference of −1.5 points (95% CI, 3.2 to −0.8; P = .06). Significant treatment effects of mechanical thrombectomy were observed in the subgroup of patients who had higher NIHSS scores on admission of 10 points or higher (mean difference, −5.6; 95% CI, −10.9 to −0.2; P = .04) and in the subgroup of patients without IVT (mean difference, −3.0; 95% CI, −5.0 to −0.9; P = .005). Symptomatic intracranial hemorrhage occurred in 4 of 92 patients (4.3%) in each treatment cohort.CONCLUSIONS AND RELEVANCE This study suggested that, although rarely performed at comprehensive stroke centers, mechanical thrombectomy for posterior circulation DMVO is a safe, and technically feasible treatment option for occlusions of the P2 or P3 segment of the PCA compared with standard medical treatment with or without IVT.

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“…Adjusted for moderately severe stroke, early neurological improvement was defined in a binary fashion as an improvement in NIHSS scores of at least 4 points from baseline or reaching 0 points at discharge. 8 Functional outcome was assessed with the modified Rankin Scale (mRS) score with excellent functional outcome defined as an mRS score of 1 point or lower. The mRS was evaluated at 90-day follow-up by a physician or a trained and certified mRS nurse that were not directly involved in the patients' treatment.…”

Section: Clinical and Safety Outcomesmentioning

confidence: 99%

Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study

Meyer

Stracke

Wallocha

et al. 2022

Stroke

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BACKGROUND: The optimal endovascular strategy for reperfusing distal medium-vessel occlusions (DMVO) remains unknown. This study evaluates angiographic and clinical outcomes of thrombectomy strategies in DMVO stroke of the posterior circulation. METHODS: TOPMOST (Treatment for Primary Medium Vessel Occlusion Stroke) is an international, retrospective, multicenter, observational registry of patients treated for DMVO between January 2014 and June 2020. This study analyzed endovascularly treated isolated primary DMVO of the posterior cerebral artery in the P2 and P3 segment. Technical feasibility was evaluated with the first-pass effect defined as a modified Thrombolysis in Cerebral Infarction Scale score of 3. Rates of early neurological improvement and functional modified Rankin Scale scores at 90 days were compared. Safety was assessed by the occurrence of symptomatic intracranial hemorrhage and intervention-related serious adverse events. RESULTS: A total of 141 patients met the inclusion criteria and were treated endovascularly for primary isolated DMVO in the P2 (84.4%, 119) or P3 segment (15.6%, 22) of the posterior cerebral artery. The median age was 75 (IQR, 62–81), and 45.4% (64) were female. The initial reperfusion strategy was aspiration only in 29% (41) and stent retriever in 71% (100), both achieving similar first-pass effect rates of 53.7% (22) and 44% (44; P =0.297), respectively. There were no significant differences in early neurological improvement (aspiration: 64.7% versus stent retriever: 52.2%; P =0.933) and modified Rankin Scale rates (modified Rankin Scale score 0–1, aspiration: 60.5% versus stent retriever 68.6%; P =0.4). In multivariable logistic regression analysis, the time from groin puncture to recanalization was associated with the first-pass effect (adjusted odds ratio, 0.97 [95% CI, 0.95–0.99]; P <0.001) that in turn was associated with early neurological improvement (aOR, 3.27 [95% CI, 1.16–9.21]; P <0.025). Symptomatic intracranial hemorrhage occurred in 2.8% (4) of all cases. CONCLUSIONS: Both first-pass aspiration and stent retriever thrombectomy for primary isolated posterior circulation DMVO seem to be safe and technically feasible leading to similar favorable rates of angiographic and clinical outcome.

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Intracranial Stenting After Failed Thrombectomy in Patients With Moderately Severe Stroke: A Multicenter Cohort Study

Cited by 23 publications

References 27 publications

Meniscus Sign in Patients with Anterior Circulation Large Vessel Occlusion Stroke does not Predict Outcome

Meniscus Sign in Patients with Anterior Circulation Large Vessel Occlusion Stroke does not Predict Outcome

Thrombectomy for Primary Distal Posterior Cerebral Artery Occlusion Stroke

Aspiration Versus Stent Retriever Thrombectomy for Distal, Medium Vessel Occlusion Stroke in the Posterior Circulation: A Subanalysis of the TOPMOST Study

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