Rescue Stenting in Mechanical Thrombectomy Refractory Occlusions: A Single Center Multiethnic Cohort

Abstract

Introduction: Refractory large vessel occlusion in acute ischemic stroke carries high morbidity and mortality. Rescue stenting is an emerging modality that is increasingly utilized especially in East Asia. We aim to investigate the safety and efficacy of performing rescue stenting in acute stroke patients who had failed mechanical thrombectomy. Methods: This is a retrospective, all-inclusive, observational, descriptive review of the prospectively collected stroke database. Post stenting, an aggressive antiplatelet protocol was followed with glycoprotein IIb/IIIa infusion. Incidence of intracerebral hemorrhage (ICH), recanalization score and favorable prognosis (modified Rankin Score ≤3) at 90 days was used to determine primary outcome. Additionally, comparison was made between patients from the Middle East and North Africa (MENA) region and others. Results: In total, 55 patients were included with 87.3% being male. Mean age was 51.3+11.8 years. This included 32 patients (58.3%) from South Asia, 12 (21.8%) from the MENA region, 9 (16.4%) from Southeast Asia and 2 (3.6%) from other parts of the world. Optimal recanalization (Thrombolysis in cerebral infarction (TICI) scale=2b-3) was achieved in 43 (78.2%); the incidence of symptomatic ICH was 2 (3.6%) and favorable outcome at 90 days was seen in 23 (41.8%). Apart from significantly older age, mean 62.8+13 years (median 69) vs. 48.1+9.3 (mean 49) and coronary artery disease burden 4 (33.3%) vs.1 (2.3%) (p<0.05). Patients from the MENA cohort had similar risk factor profiles, stroke severity, recanalization rates, ICH rates and 90-day outcomes compared to patients from South and Southeast Asia. Conclusion: Rescue stenting showed comparably good outcomes and low risk of clinically significant bleeding in a multiethnic cohort of patients from MENA and South and Southeast Asia.

Rescue intracranial permanent stenting for refractory occlusion following thrombectomy: a propensity matched analysis

“…Among plausible issues to improve the outcome of patients treated for an AIS due to LVO, RIS has been increasingly used and reported to increase the rates of recanalization after standard MT failure or early reocclusions,3–6 12 and several dedicated trials are underway 13.…”

“…Patients with refractory occlusions harbor a very severe prognosis, in terms of functional outcome and mortality. Intracranial stenting is increasingly reported in acute conditions as a rescue technique for maintaining vessel permeability 3–6. Rescue intracranial stenting (RIS) poses several challenges in the context of AIS, most notably for the management of antithrombotic regimens.…”