Rescue Stenting for Failed Mechanical Thrombectomy in Acute Ischemic Stroke A Multicenter Experience

被引：151

作者：

Chang, Yoonkyung ^{[1
]}

Kim, Byung Moon ^{[1
]}

Bang, Oh Young ^{[4
]}

Baek, Jang-Hyun ^{[6
]}

Heo, Ji Hoe ^{[2
]}

Nam, Hyo Suk ^{[2
]}

Kim, Young Dae ^{[2
]}

Yoo, Joonsang ^{[7
]}

Kim, Dong Joon ^{[1
]}

Jeon, Pyoung ^{[5
]}

Baik, Seung Kug ^{[8
]}

Suh, Sang Hyun ^{[9
]}

Lee, Kyung-Yul ^{[3
]}

Kwak, Hyo Sung ^{[10
]}

Roh, Hong Gee ^{[12
,13
]}

Lee, Young-Jun ^{[14
]}

Kim, Sang Heum ^{[15
]}

Ryu, Chang-Woo ^{[16
]}

Ihn, Yon-Kwon ^{[17
]}

Kim, Byungjun ^{[18
]}

Jeon, Hong Jun ^{[19
]}

Kim, Jin Woo ^{[20
]}

Byun, Jun Soo ^{[21
]}

Suh, Sangil ^{[23
]}

Park, Jeong Jin ^{[24
]}

Lee, Woong Jae ^{[21
]}

Roh, Jieun ^{[8
]}

Shin, Byoung-Soo ^{[11
]}

Kim, Jeong-Min ^{[22
]}

机构：

[1] Yonsei Univ, Coll Med, Severance Hosp, Severance Stroke Ctr,Dept Radiol, Seoul, South Korea

[2] Yonsei Univ, Coll Med, Severance Hosp, Severance Stroke Ctr,Dept Neurol, Seoul, South Korea

[3] Yonsei Univ, Coll Med, Gangnam Severance Hosp, Dept Neurol, Seoul, South Korea

[4] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Neurol, Seoul, South Korea

[5] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Radiol, Seoul, South Korea

[6] Natl Med Ctr, Dept Neuro, Seoul, South Korea

[7] Keimyung Univ, Sch Med, Dept Neurol, Daegu, South Korea

[8] Pusan Natl Univ, Sch Med, Yangsan Hosp, Dept Radiol, Yangsan, South Korea

[9] Yonsei Univ, Gangnam Severance Hosp, Dept Radiol, Seoul, South Korea

[10] Chonbuk Natl Univ, Med Sch & Hosp, Dept Radiol, Jeonju, South Korea

[11] Chonbuk Natl Univ, Med Sch & Hosp, Dept Neurol, Jeonju, South Korea

[12] Konkuk Univ, Med Ctr, Dept Radiol, Seoul, South Korea

[13] Sch Med, Seoul, South Korea

[14] Hanyang Univ, Coll Med & Hosp, Dept Radiol, Seoul, South Korea

[15] CHA Univ, CHA Bundang Med Ctr, Dept Radiol, Seongnam, South Korea

[16] Kyung Hee Univ, Sch Med, Hosp Gangdong, Dept Radiol, Seoul, South Korea

[17] Catholic Univ Korea, Coll Med, St Vincents Hosp, Dept Radiol, Suwon, South Korea

[18] Korea Univ, Anam Hosp, Dept Radiol, Seoul, South Korea

[19] Hallym Univ, Coll Med, Kangdong Sacred Heart Hosp, Dept Neurosurg, Seoul, South Korea

[20] Inje Univ, Ilsan Paik Hosp, Dept Radiol, Goyang, South Korea

[21] Chung Ang Univ Hosp, Dept Radiol, Seoul, South Korea

[22] Chung Ang Univ Hosp, Dept Neurol, Seoul, South Korea

[23] Korea Univ, Coll Med, Guro Hosp, Dept Radiol, Seoul, South Korea

[24] Konkuk Univ, Sch Med, Konkuk Univ Hosp, Dept Neurol, Seoul, South Korea

来源：

STROKE | 2018年 / 49卷 / 04期

关键词：

middle cerebral artery; stents; stroke; thrombectomy; ENDOVASCULAR TREATMENT; RETRIEVER THROMBECTOMY; RECANALIZATION; OCCLUSION; METAANALYSIS; TIROFIBAN; THERAPY; FAILURE; TRIAL;

D O I：

10.1161/STROKEAHA.117.020072

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-Effective rescue treatment has not yet been suggested in patients with mechanical thrombectomy (MT) failure. This study aimed to test whether rescue stenting (RS) improved clinical outcomes in MT-failed patients. Methods-This is a retrospective analysis of the cohorts of the 16 comprehensive stroke centers between September 2010 and December 2015. We identified the patients who underwent MT but failed to recanalize intracranial internal carotid artery or middle cerebral artery M1 occlusion. Patients were dichotomized into 2 groups: patients with RS and without RS after MT failure. Clinical and laboratory findings and outcomes were compared between the 2 groups. It was tested whether RS is associated with functional outcome. Results-MT failed in 148 (25.0%) of the 591 patients with internal carotid artery or middle cerebral artery M1 occlusion. Of these 148 patients, 48 received RS (RS group) and 100 were left without further treatment (no stenting group). Recanalization was successful in 64.6% (31 of 48 patients) of RS group. Compared with no stenting group, RS group showed a significantly higher rate of good outcome (modified Rankin Scale score, 0-2; 39.6% versus 22.0%; P=0.031) without increasing symptomatic intracranial hemorrhage (16.7% versus 20.0%; P=0.823) or mortality (12.5% versus 19.0%; P=0.360). Of the RS group, patients who had recanalization success had 54.8% of good outcome, which is comparable to that (55.4%) of recanalization success group with MT. RS remained independently associated with good outcome after adjustment of other factors (odds ratio, 3.393; 95% confidence interval, 1.192-9.655; P=0.022). Follow-up vascular imaging was available in the 23 (74.2%) of 31 patients with recanalization success with RS. The stent was patent in 20 (87.0%) of the 23 patients. Glycoprotein IIb/IIIa inhibitor was significantly associated with stent patency but not with symptomatic intracranial hemorrhage. Conclusions-RS was independently associated with good outcomes without increasing symptomatic intracranial hemorrhage or mortality. RS seemed considered in MT-failed internal carotid artery or middle cerebral artery M1 occlusion.

引用

页码：958 / 964

页数：7

共 21 条

[1] Predictive Value of Computed Tomography Angiography-Determined Occlusion Type in Stent Retriever Thrombectomy [J].

Baek, Jang-Hyun ;

Kim, Byung Moon ;

Yoo, Joonsang ;

Nam, Hyo Suk ;

Kim, Young Dae ;

Kim, Dong Joon ;

Heo, Ji Hoe ;

Bang, Oh Young .

STROKE, 2017, 48 (10) :2746-+

[2] Importance of truncal-type occlusion in stentriever-based thrombectomy for acute stroke [J].

Baek, Jang-Hyun ;

Kim, Byung Moon ;

Kim, Dong Joon ;

Heo, Ji Hoe ;

Nam, Hyo Suk ;

Song, Dongbeom ;

Bang, Oh Young .

NEUROLOGY, 2016, 87 (15) :1542-1550

[3] Stenting as a Rescue Treatment After Failure of Mechanical Thrombectomy for Anterior Circulation Large Artery Occlusion [J].

Baek, Jang-Hyun ;

Kim, Byung Moon ;

Kim, Dong Joon ;

Heo, Ji Hoe ;

Nam, Hyo Suk ;

Yoo, Joonsang .

STROKE, 2016, 47 (09) :2360-2363

[4] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[5] Stent Placement in Acute Cerebral Artery Occlusion Use of a Self-Expandable Intracranial Stent for Acute Stroke Treatment [J].

Brekenfeld, Caspar ;

Schroth, Gerhard ;

Mattle, Heinrich P. ;

Do, Do-Dai ;

Remonda, Luca ;

Mordasini, Pasquale ;

Arnold, Marcel ;

Nedeltchev, Krassen ;

Meier, Niklaus ;

Gralla, Jan .

STROKE, 2009, 40 (03) :847-852

[6] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[7] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[8] Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials [J].

Goyal, Mayank ;

Menon, Bijoy K. ;

van Zwam, Wim H. ;

Dippel, Diederik W. J. ;

Mitchell, Peter J. ;

Demchuk, Andrew M. ;

Davalos, Antoni ;

Majoie, Charles B. L. M. ;

van der Lugt, Aad ;

de Miquel, Maria A. ;

Donnan, Geoff Rey A. ;

Roos, Yvo B. W. E. M. ;

Bonafe, Alain ;

Jahan, Reza ;

Diener, Hans-Christoph ;

van den Berg, Lucie A. ;

Levy, Elad I. ;

Berkhemer, Olvert A. ;

Pereira, Vitor M. ;

Rempel, Jeremy ;

Millan, Monica ;

Davis, Stephen M. ;

Roy, Daniel ;

Thornton, John ;

San Roman, Luis ;

Ribo, Marc ;

Beumer, Debbie ;

Stouch, Bruce ;

Brown, Scott ;

Campbell, Bruce C. V. ;

van Oostenbrugge, Robert J. ;

Saver, Jeff Rey L. ;

Hill, Michael D. ;

Jovin, Tudor G. .

LANCET, 2016, 387 (10029) :1723-1731

[9] Update of the Korean Clinical Practice Guidelines for Endovascular Recanalization Therapy in Patients with Acute Ischemic Stroke [J].

Hong, Keun-Sik ;

Ko, Sang-Bae ;

Yu, Kyung-Ho ;

Jung, Cheolkyu ;

Park, Sukh Que ;

Kim, Byung Moon ;

Chang, Chul-Hoon ;

Bae, Hee-Joon ;

Heo, Ji Hoe ;

Oh, Chang Wan ;

Lee, Byung-Chul ;

Kim, Bum-Tae ;

Kim, Bum-soo ;

Chung, Chin -Sang ;

Yoon, Byung-Woo ;

Rha, Joung-Ho .

JOURNAL OF STROKE, 2016, 18 (01) :102-113

[10] Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke [J].

Jovin, T. G. ;

Chamorro, A. ;

Cobo, E. ;

de Miquel, M. A. ;

Molina, C. A. ;

Rovira, A. ;

San Roman, L. ;

Serena, J. ;

Abilleira, S. ;

Ribo, M. ;

Millan, M. ;

Urra, X. ;

Cardona, P. ;

Lopez-Cancio, E. ;

Tomasello, A. ;

Castano, C. ;

Blasco, J. ;

Aja, L. ;

Dorado, L. ;

Quesada, H. ;

Rubiera, M. ;

Hernandez-Perez, M. ;

Goyal, M. ;

Demchuk, A. M. ;

von Kummer, R. ;

Gallofre, M. ;

Davalos, A. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (24) :2296-2306

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