Intracranial Stenting after Failure of Thrombectomy with the emboTrap® Device

Cornelissen, Sandra; Andersson, Tommy; Holmberg, Åke; Brouwer, Patrick A.; Söderman, Michael; Bhogal, Pervinder; Yeo, Leonard L.L.

doi:10.1007/s00062-018-0697-x

Cited by 27 publications

(21 citation statements)

References 29 publications

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“…However, a post hoc subanalysis showed that there were no outcome differences in SAMMPRIS patients comparing early and late therapy initiation after the qualifying event 20. The question of the best timing for endovascular therapy is still a matter of current debate since the latest results on stenting for acute stroke patients with tandem occlusions or after failed thrombectomy showed no increased risk of ICH, in some cases even combined with IVT 7 21–23. Thus antithrombotic therapy management might be more important than timing.…”

Section: Discussionmentioning

confidence: 99%

Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention

Meyer

Leischner

Thomalla

et al. 2020

J NeuroIntervent Surg

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Background and purposeStroke recurrence is high in patients with symptomatic intracranial stenosis despite best medical treatment. Based on evidence from past studies using previous stent generations, elective intracranial stenting (eICS) is considered in a minority of patients. This study aims to report on experience performing eICS with a novel device combination.MethodsWe retrospectively reviewed data from three high volume stroke centers and analyzed patients that were treated with eICS for symptomatic intracranial stenosis using the Acclino® (flex) stent and the NeuroSpeed® balloon catheter (Acandis GmbH, Pforzheim, Germany). Study endpoints were periprocedural rates of stroke regardless of territory or death at discharge and at the time of follow-up after eICS. Safety evaluation included asymptomatic and symptomatic intracranial hemorrhage, serious adverse events related to the intervention, and evaluation of stent patency at the time of follow-up.ResultsThe median age of patients that met the inclusion criteria (n=76) was 69 years. Target vessels were located in the anterior circulation in 55.3% (42/76) of patients. The periprocedural stroke rate was 6.5% (fatal stroke 2.6%; non-fatal stroke 3.9%) at discharge after eICS. Asymptomatic intracranial hemorrhage was observed in 5.2% (4/76) of patients. Follow-up DSA revealed in-stent restenosis of 25% (15/60), and percutaneous transluminal angioplasty was performed again in 11.6% (7/60) of patients.ConclusionStenting for symptomatic intracranial stenosis with the Acclino® (flex)/NeuroSpeed balloon® catheter seemed to be safe and reinforces eICS as an endovascular therapy option for secondary stroke prevention. Future studies are warranted to confirm these findings and investigate antithrombotic strategies and in-stent restenosis to minimize periprocedural complications and guarantee long term stent patency.

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Section: Discussionmentioning

confidence: 99%

Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention

Meyer

Leischner

Thomalla

et al. 2020

J NeuroIntervent Surg

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“…In recent years, evaluating the efficacy and safety of rescue stenting (RS) in patients with proximal vessel occlusion in the anterior circulation has attracted much interest. Previous studies indicate that RS is significantly associated with successful reperfusion and good outcomes without increasing the risk of symptomatic intracranial hemorrhage (sICH) or mortality 10–13. Nevertheless, further investigation is needed to confirm any conclusions reached on this subject because of the relatively small numbers of patients who have been treated with RS.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of rescue stenting following failed mechanical thrombectomy for anterior circulation large vessel occlusion: propensity score analysis

Peng

Wan

Liu

et al. 2019

J NeuroIntervent Surg

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PurposeTo evaluate the effectiveness and safety of rescue stenting (RS) after failed mechanical thrombectomy (MT) for patients with large artery occlusion in the anterior circulation.MethodsConsecutive patients who experienced failed reperfusion and subsequently did or did not undergo RS at 16 comprehensive stroke centers were enrolled from January 2015 to June 2018. Propensity score matching was used to achieve baseline balance between the patient groups. Symptomatic intracranial hemorrhage (sICH) at 48 hours and the modified Rankin Scale scores and mortality at 3 months in the two groups were compared.ResultsA total of 90 patients with RS and 117 patients without RS after failed MT were enrolled. Propensity score matching analysis selected 132 matched patients. The good outcome rate was significantly higher in matched patients with RS than in those without RS (36.4% vs 19.7%, p=0.033), whereas the sICH (13.6% vs 21.2%, p=0.251) and mortality (31.9% vs 43.9%, p=0.151) were not significantly different between the groups.ConclusionsRS seems to be an effective safe choice for patients with large vessel occlusion of the anterior circulation who underwent failed MT.

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“…Due to the retrospective and anonymized study design, informed consent of the patients was not required. Some data were part of previously published cohorts (7,11).…”

Section: Patient Selectionmentioning

confidence: 99%

“…Accordingly, the best currently available evidence for the endovascular treatment of ICAD is based on the SAMMPRIS and the VISSIT study (4,5) showing the superiority of best medical treatment over elective intracranial stenting. Recently, acute intracranial stenting (ICS) has been reported to be a highly promising bailout strategy for theses frustrating thrombectomy cases with predictably poor outcomes (6)(7)(8)(9)(10)(11). Since these cases are still rare, past retrospective studies mostly analyzed heterogeneous cohorts, including a wide range of stroke severities (12).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Results: Forty-one patients met the inclusion criteria. A median of 2 retrievals were performed (IQR 1-4) prior decision-making for ICS. ICS led in 90.2% (37/41) of cases to a final mTICI≥2b with significant improvement (p < 0.001) after the last retrieval attempt. The median NIHSS decreased (p = 0.178) from 7 (IQR 3.5-8) on admission to 2.5 (IQR 0-8.25) at discharge. ENI was observed in 47.4% (18/38). sICH occurred in 4.8% (2/41). Conclusion: ICS after failed thrombectomy appears to effectively improve recanalization rates in patients with moderately severe strokes. Thus, ICS should be considered also for patients with baseline NIHSS ≤9 if thrombectomy fails.

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Intracranial Stenting after Failure of Thrombectomy with the emboTrap® Device

Abstract: Intracranial stenting after failure of recanalization with thrombectomy led to a better rate of clinical outcome than leaving the patient non-recanalized. The required antiplatelet therapy, predominantly abciximab, did not lead to additional ICH.

Cited by 27 publications

References 29 publications

Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention

Stenting with Acclino (flex) for symptomatic intracranial stenosis as secondary stroke prevention

Efficacy and safety of rescue stenting following failed mechanical thrombectomy for anterior circulation large vessel occlusion: propensity score analysis

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

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