Stracke, Christian Paul, Fiehler, Jens, Meyer, Lukas ORCID: 0000-0002-3776-638X, Thomalla, Goetz, Krause, Lars Udo, Lowens, Stephan, Rothaupt, Jan, Kim, Byung Moon ORCID: 0000-0001-8593-6841, Heo, Ji Hoe ORCID: 0000-0001-9898-3321, Yeo, Leonard L. L., Andersson, Tommy, Kabbasch, Christoph, Dorn, Franziska, Chapot, Rene and Hanning, Uta ORCID: 0000-0002-7543-8555 (2020). Emergency Intracranial Stenting in Acute Stroke: Predictors for Poor Outcome and for Complications. J. Am. Heart Assoc., 9 (5). HOBOKEN: WILEY. ISSN 2047-9980

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Abstract

Background Stent-retriever thrombectomy is the first-line therapy in acute stroke with intracranial large vessel occlusion. In case of failure of stent-retriever thrombectomy, rescue stent angioplasty might be the only treatment option to achieve permanent recanalization. This study aims at identifying predictors for poor outcome and complications in a large, multicenter cohort receiving rescue stent angioplasty. Methods and Results We performed a retrospective analysis of patients with large vessel occlusion who were treated with rescue stent angioplasty after stent-retriever thrombectomy between 2012 and 2018 in 7 neurovascular centers. We defined 2 binary outcomes: (1) functional clinical outcome (good modified Rankin Scale, 0-2; and poor modified Rankin Scale, 4-6) and (2) early symptomatic intracerebral hemorrhage. Impacts of clinical, radiological, and interventional parameters on outcomewere assessed in uni- and multivariable logistic regression models. Two hundred ten patients were included with target vessels located within the anterior circulation (136 of 210; 64.8%) and posterior circulation (74 of 210; 35.2%). Symptomatic intracerebral hemorrhage occured in 22 patients, 86.4% (19 of 22) after anterior and 13.6% (3 of 22) after posterior circulation large vessel occlusion. Good functional outcome was observed in 44.8% (73 of 163). A higher National Institutes of Health Stroke Scale on admission (adjusted odds ratio, 1.10; P=0.002), a higher premorbid modified Rankin Scale (adjusted odds ratio, 2.02; P=0.049), and a modified Thrombolysis in Cerebral Infarction score of 0 to 2a after stenting (adjusted odds ratio, 23.24; P<0.001) were independent predictors of poor functional outcome. Conclusions Use of rescue stent angioplasty can be considered for acute intracranial large vessel occlusion in cases after unsuccessful stent-retriever thrombectomy. Likelihood of symptomatic intracerebral hemorrhage is higher in anterior circulation stroke.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Stracke, Christian PaulUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fiehler, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meyer, LukasUNSPECIFIEDorcid.org/0000-0002-3776-638XUNSPECIFIED
Thomalla, GoetzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Krause, Lars UdoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lowens, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rothaupt, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kim, Byung MoonUNSPECIFIEDorcid.org/0000-0001-8593-6841UNSPECIFIED
Heo, Ji HoeUNSPECIFIEDorcid.org/0000-0001-9898-3321UNSPECIFIED
Yeo, Leonard L. L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Andersson, TommyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kabbasch, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dorn, FranziskaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chapot, ReneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hanning, UtaUNSPECIFIEDorcid.org/0000-0002-7543-8555UNSPECIFIED
URN: urn:nbn:de:hbz:38-341500
DOI: 10.1161/JAHA.119.012795
Journal or Publication Title: J. Am. Heart Assoc.
Volume: 9
Number: 5
Date: 2020
Publisher: WILEY
Place of Publication: HOBOKEN
ISSN: 2047-9980
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ACUTE ISCHEMIC-STROKE; MECHANICAL THROMBECTOMY; ENDOVASCULAR TREATMENT; ARTERY-OCCLUSION; RESCUE TREATMENT; STENOSIS; THERAPY; RECOMMENDATIONS; ANGIOPLASTY; REOCCLUSIONMultiple languages
Cardiac & Cardiovascular SystemsMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/34150

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