Predictors and Clinical Impact of Delayed Stent Thrombosis after Thrombectomy for Acute Stroke with Tandem Lesions.

Autor:	Pop R; From the Interventional Neuroradiology Department (R.P., D.M., M.M., J.S.R., R.B.) pop.raoul@gmail.com.; Institut Hopitalo-Universitaire Strasbourg (R.P., R.B.), Strasbourg, France., Zinchenko I; Stroke Unit (I.Z., V.Q., O.R., V.W.)., Quenardelle V; Stroke Unit (I.Z., V.Q., O.R., V.W.)., Mihoc D; From the Interventional Neuroradiology Department (R.P., D.M., M.M., J.S.R., R.B.)., Manisor M; From the Interventional Neuroradiology Department (R.P., D.M., M.M., J.S.R., R.B.)., Richter JS; From the Interventional Neuroradiology Department (R.P., D.M., M.M., J.S.R., R.B.).; EA3072, FMTS (J.S.R., O.R., V.W.), University of Strasbourg, Strasbourg, France., Severac F; Public Healthcare Department (F.S.)., Simu M; Neurology Department (M.S.), Victor Babes University of Medicine, Timisoara, Romania., Chibbaro S; Neurosurgery Department (S.C.), Strasbourg University Hospitals, Strasbourg, France., Rouyer O; Stroke Unit (I.Z., V.Q., O.R., V.W.).; EA3072, FMTS (J.S.R., O.R., V.W.), University of Strasbourg, Strasbourg, France., Wolff V; Stroke Unit (I.Z., V.Q., O.R., V.W.).; EA3072, FMTS (J.S.R., O.R., V.W.), University of Strasbourg, Strasbourg, France., Beaujeux R; From the Interventional Neuroradiology Department (R.P., D.M., M.M., J.S.R., R.B.).; Institut Hopitalo-Universitaire Strasbourg (R.P., R.B.), Strasbourg, France.
Jazyk:	angličtina
Zdroj:	AJNR. American journal of neuroradiology [AJNR Am J Neuroradiol] 2019 Mar; Vol. 40 (3), pp. 533-539. Date of Electronic Publication: 2019 Feb 14.
DOI:	10.3174/ajnr.A5976
Abstrakt:	Background and Purpose: There are very few published data on the patency of carotid stents implanted during thrombectomies for tandem lesions in the anterior circulation. We aimed to communicate our experience of stenting in the acute setting with systematic follow-up of stent patency and discuss predictors and clinical repercussions of delayed stent thrombosis. Materials and Methods: We performed a retrospective study of stroke thrombectomies in a single center between January 2009 and April 2018. Patient files were reviewed to extract patient characteristics, procedural details, imaging studies, and clinical information. Predictors of delayed stent thrombosis and clinical outcome at discharge were analyzed using univariate and multivariate analyses. Results: We identified 81 patients treated for tandem lesions: 63 (77.7%) atheromas, 17 (20.9%) dissections, and 1 (1.2%) carotid web. TICI 2b-3 recanalization was achieved in 70 (86.4%) cases. Thirty-five patients (43.2%) were independent (mRS score ≤ 2) at discharge. Among 73 patients with intracranial recanalization and patent stents at the end of the procedure, delayed stent thrombosis was observed in 14 (19.1%). Among 59 patients with patent stents, 44 had further imaging controls (median, 105 days; range, 2-2407 days) and 1 (1.6%) had 50% in-stent stenosis with no retreatment. Stent occlusion rates were 11/39 (28.2%) for periprocedural aspirin treatment versus 3/34 (8.8%) for aspirin and clopidogrel ( P = .04). Delayed stent thrombosis was independently associated with higher admission NIHSS scores (OR, 1.1; 95% CI, 1.01-1.28), diabetes (OR, 6.07; 95% CI, 1.2-30.6), and the presence of in-stent thrombus on the final angiographic run (OR, 6.2; 95% CI, 1.4-27.97). Delayed stent thrombosis (OR, 19.78; 95% CI, 2.78-296.83), higher admission NIHSS scores (OR, 1.27, 95% CI, 1.12-1.51), and symptomatic hemorrhagic transformation (OR, 23.65; 95% CI, 1.85-3478.94) were independent predictors of unfavorable clinical outcome at discharge. Conclusions: We observed a non-negligible rate of delayed stent thrombosis with significant negative impact on clinical outcome. Future studies should systematically measure and report stent patency rates. (© 2019 by American Journal of Neuroradiology.)
Databáze:	MEDLINE
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