Stentriever Thrombectomy Failure: A Challenge in Stroke Management

Baracchini, Claudio; Farina, Filippo; Soso, Matteo; Viaro, Federica; Favaretto, Silvia; Palmieri, Anna; Kulyk, Caterina; Ballotta, Enzo; Nico, Lorena; Cester, Giacomo; Causin, Francesco

doi:10.1016/j.wneu.2017.03.070

Cited by 28 publications

(14 citation statements)

References 22 publications

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“…Three recent cohort studies found that the successful reperfusion rate of RS following failed MT was 64.6–83.3%, the good outcome rate was 35.3–56.5%, the sICH rate was 4.3–16.7%, and the mortality rate was 4.3–23.5%. Thus, the results in patients who underwent RS after failed MT were superior to those for patients who did not undergo RS after MT failure 10–12. The proportions of favorable outcomes and sICH in patients in the present study who underwent RS were similar to those in previous studies,10–12 although there was a higher incidence of mortality.…”

Section: Discussionsupporting

confidence: 78%

“…Thus, the results in patients who underwent RS after failed MT were superior to those for patients who did not undergo RS after MT failure 10–12. The proportions of favorable outcomes and sICH in patients in the present study who underwent RS were similar to those in previous studies,10–12 although there was a higher incidence of mortality. The median time from onset to puncture was longer in the present study, which may be an important reason for the higher mortality risk.…”

Section: Discussionsupporting

confidence: 78%

“…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%

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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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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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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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“…The Interventional Management of Stroke (IMS) 1 and 2 trials41 42 gave relatively reliable data on the efficacy and safety of intra-arterial alteplase administration with SICH rates of 6.3–9.9% but the efficacy for thrombectomy resistant thrombi must be questioned. Additionally, rescue intra-arterial infusion of tirofiban alone was shown to be relatively ineffective by Barranchini et al 27 who demonstrated in a European population that only 3 of 19 patients attained successful reperfusion with intra-arterial tirofiban infusion after failed thrombectomy. Just as stent retrievers represented an evolutionary leap in the treatment of ELVO over the Merci device,43 44 more recently a newer generation of devices, including Embotrap (Ceronovus), have been developed with the aim of facilitating the removal of more resistant thrombi but the real world efficacy compared with traditional stent retrievers is as yet untested.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of observational evidence for the use of bailout self-expandable stents following failed anterior circulation stroke thrombectomy

Wareham

Flood

Phan³

et al. 2018

J NeuroIntervent Surg

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BackgroundThe crucial role of thrombectomy in the management of emergent large vessel occlusive stroke is not disputed but there is a technical failure rate in a significant minority of patients whose outcomes are often poor. Our objective was to perform a systematic review and meta-analysis to assess the safety and efficacy of permanent self-expandable stent deployment as a bailout procedure in cases of failed anterior circulation thrombectomy.MethodsTwo independent reviewers searched the Pubmed (Medline) database for studies reporting outcomes following failed endovascular thrombectomy with subsequent rescue therapy employing self-expandable stents.ResultsEight studies (one prospective, seven retrospective) originating from Europe, Asia, and America comprising 160 patients met the inclusion criteria. Estimated baseline National Institutes of Health Stroke Scale score was 17.1 (95% CI 15.7 to 18.4). Following failed thrombetcomy and stent deployment, the rate of favorable outcome (modified Rankin Scale score 0–2) was 43% (95% CI 34% to 53%). Pooled mortality was 21% (95% CI 13% to 33%). Successful recanalization (Thrombolysis in Cerebral Infarction (TICI) 2b–3 or Thrombolysis in Myocardial Infarction (TIMI) 2–3) was 71% (95% CI 63% to 77%). Symptomatic intracerebral hemorrhage was seen in 12% (95% CI 7% to 18%). The Solitaire stent (Medtronic) was the most commonly deployed stent following failed thrombectomy attempts (66%; 95% CI 31% to 89%). Pre- or post-stent angioplasty was performed in 39%of patients (95% CI 29% to 48%). Glycoprotein IIb/IIIa inhibitors were used in 89% (95% CI 71% to 97%). 95% of patients received postprocedural antiplatelet therapy.ConclusionA rescue stent procedure seems reasonable as a last resort following failed thrombectomy but currently the level of evidence is limited. Prospective registries may aid in guiding future recommendations.

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“…The Enterprise® stent and Solitaire™ AB are self-expanding closed-cell stents, which were initially designed to assist in the coiling of brain aneurysms. They have been employed as a revascularization device for use in AIS after other devices have failed [5, 17]. While the closed cell design provides good radial force, a study using the Enterprise® for primary stenting during AIS suggested that balloon angioplasty after stent deployment was required in 45% of the cases [10].…”

Section: Discussionmentioning

confidence: 99%