Rescue intracranial stenting for failed posterior circulation thrombectomy: analysis from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study.

Autor:	Mohammaden, Mahmoud H., Tarek, Mohamed A., Nour, Hassan Aboul, Haussen, Diogo C., Fifi, Johanna T., Matsoukas, Stavros, Farooqui, Mudassir, Ortega-Gutierrez, Santiago, Zevallos, Cynthia B., Galecio-Castillo, Milagros, Hassan, Ameer E., Tekle, Wondwossen, Al-Bayati, Alhamza R., Salem, Mohamed M., Burkhardt, Jan Karl, Pukenas, Bryan, Cortez, Gustavo M., Hanel, Ricardo A., Aghaebrahim, Amin, Sauvageau, Eric
Předmět:	PREVENTION of surgical complications TRANSLUMINAL angioplasty INTRACRANIAL hemorrhage BASILAR artery PATIENT safety DEATH SURGICAL stents TREATMENT effectiveness RETROSPECTIVE studies DESCRIPTIVE statistics VERTEBRAL artery ODDS ratio ARTERIAL occlusions CEREBRAL infarction THROMBECTOMY TREATMENT failure CONFIDENCE intervals COMPARATIVE studies
Zdroj:	Journal of NeuroInterventional Surgery; Oct2024, Vol. 16 Issue 10, p974-980, 8p
Abstrakt:	Backgrounds Recent trials have shown improved outcomes after mechanical thrombectomy (MT) for vertebrobasilar occlusion (VBO) stroke. However, there is a paucity of data regarding safety and outcomes of rescue intracranial stenting (RS) after failed MT (FRRS+) for posterior circulation stroke. We sought to compare RS to failed reperfusion without RS (FRRS-). Methods This is a retrospective analysis of the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study, a multicenter collaboration involving prospectively collected databases. Patients were included if they had posterior circulation stroke and failed MT. The cohort was divided into two groups: FRRS+ and FRRS- (defined as modified Thrombolysis In Cerebral Infarction (mTICI) score 0-2a). The primary outcome was a shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included mRS 0-2 and mRS 0-3 at 90 days. Safety measures included rates of symptomatic intracranial hemorrhage (sICH), procedural complications, and 90-day mortality. Sensitivity and subgroup analyses were performed to identify outcomes in a matched cohort and in those with VBO, respectively. Results A total of 152 failed thrombectomies were included in the analysis. FRRS+ (n=84) was associated with increased likelihood of lower disability (acOR 2.24, 95% CI 1.04 to 4.95, P=0.04), higher rates of mRS 0-2 (26.8% vs 12.5%, aOR 4.43, 95% CI 1.22 to 16.05, P=0.02) and mRS 0-3 (35.4% vs 18.8%, aOR 3.13, 95% CI 1.08 to 9.10, P=0.036), and lower mortality (42.7% vs 59.4%, aOR 0.40, 95% CI 0.17 to 0.97, P=0.04) at 90 days compared with FRRS- (n=68). The rates of sICH and procedural complications were comparable between the groups. Sensitivity and subgroup analyses showed similar results. Conclusion In patients with posterior circulation stroke who had failed MT, RS resulted in better functional outcomes with comparable safety profile to procedure termination. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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