Rescue Intracranial Stenting After Failed Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

Endovascular Procedures / instrumentation Humans Mechanical Thrombolysis Stents Stroke / therapy
Acute ischemic stroke Angioplasty Intracranial atherosclerosis Stenting Thrombectomy

Journal

World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275

Informations de publication

Date de publication:
Dec 2019
Historique:
received: 30 07 2019
revised: 22 08 2019
accepted: 24 08 2019
pubmed: 8 9 2019
medline: 24 1 2020
entrez: 8 9 2019
Statut: ppublish

Résumé

Up to 20% of patients fail to achieve reperfusion with modified Thrombolysis in Cerebral Infarction (mTICI) scores of 0-1 after mechanical thrombectomy (MT). Furthermore, underlying intracranial atherosclerotic disease, particularly when associated with >70% residual or flow limiting stenosis, is associated with higher rates of failed MT and high failure risk MT. The aim of this study was to systematically review the procedural and clinical outcomes in patients with failed MT and high failure risk MT. We also explored differences between patients receiving acute rescue stenting compared with medical management alone. A systematic literature search was conducted in Ovid MEDLINE, PubMed, Embase, and Cochrane online scientific publication databases for English language publications from their date of inception until October 2018. Studies including adult patients with acute ischemic stroke because of emergent large vessel occlusion with failed (mTICI score 0-1) or high failure risk MT within the anterior circulation who underwent rescue stenting were included. A systematic review and meta-analysis of proportions was performed. Rescue intracranial stenting after failed MT or high failure risk MT results in improved clinical outcomes compared with patients without stenting (48.5% vs. 19.7%, respectively; P < 0.001), without an increase in the rate of symptomatic intracranial hemorrhage, despite additional use of antiplatelet agents (9.7% vs. 14.1%, respectively; P = 0.04). In patients who fail initial attempts at MT or are high risk for acute reocclusion, rescue intracranial stenting could be considered with the aim to improve functional outcomes. Antiplatelet agents do not increase the risk of hemorrhage in these patients.

Sections du résumé

BACKGROUND BACKGROUND
Up to 20% of patients fail to achieve reperfusion with modified Thrombolysis in Cerebral Infarction (mTICI) scores of 0-1 after mechanical thrombectomy (MT). Furthermore, underlying intracranial atherosclerotic disease, particularly when associated with >70% residual or flow limiting stenosis, is associated with higher rates of failed MT and high failure risk MT. The aim of this study was to systematically review the procedural and clinical outcomes in patients with failed MT and high failure risk MT. We also explored differences between patients receiving acute rescue stenting compared with medical management alone.
METHODS METHODS
A systematic literature search was conducted in Ovid MEDLINE, PubMed, Embase, and Cochrane online scientific publication databases for English language publications from their date of inception until October 2018. Studies including adult patients with acute ischemic stroke because of emergent large vessel occlusion with failed (mTICI score 0-1) or high failure risk MT within the anterior circulation who underwent rescue stenting were included. A systematic review and meta-analysis of proportions was performed.
RESULTS RESULTS
Rescue intracranial stenting after failed MT or high failure risk MT results in improved clinical outcomes compared with patients without stenting (48.5% vs. 19.7%, respectively; P < 0.001), without an increase in the rate of symptomatic intracranial hemorrhage, despite additional use of antiplatelet agents (9.7% vs. 14.1%, respectively; P = 0.04).
CONCLUSIONS CONCLUSIONS
In patients who fail initial attempts at MT or are high risk for acute reocclusion, rescue intracranial stenting could be considered with the aim to improve functional outcomes. Antiplatelet agents do not increase the risk of hemorrhage in these patients.

Identifiants

DOI: 10.1016/j.wneu.2019.08.192 PMID: 31493593
pubmed: 31493593
pii: S1878-8750(19)32348-4
doi: 10.1016/j.wneu.2019.08.192
pii:
doi:

Types de publication

Journal Article Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

e235-e245

Informations de copyright

Copyright © 2019 Elsevier Inc. All rights reserved.

Auteurs

Julian Maingard (J)

Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia. Electronic address: julian.maingard@gmail.com.

Kevin Phan (K)

NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, New South Wales, Australia.

Anthony Lamanna (A)

Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Victoria, Australia.

Hong Kuan Kok (HK)

School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia; Interventional Radiology Service, Department of Radiology, Northern Hospital, Melbourne, Victoria, Australia.

Christen D Barras (CD)

South Australian Institute of Health and Medical Research, Adelaide, South Australia, Australia; School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia.

Jeremy Russell (J)

Department of Neurosurgery, Austin Hospital, Melbourne, Victoria, Australia.

Joshua A Hirsch (JA)

Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Ronil V Chandra (RV)

Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia; Department of Imaging, Monash University, Melbourne, Victoria, Australia.

Vincent Thijs (V)

Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; School of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Department of Neurology, Austin Health, Melbourne, Victoria, Australia.

Mark Brooks (M)

School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia; Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.

Hamed Asadi (H)

Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia; Interventional Neuroradiology Service, Radiology Department, Austin Hospital, Melbourne, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.

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Classifications MeSH

questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Procédures endovasculaires › Rescue Intracranial Stenting After Failed...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Rescue Intracranial Stenting After Failed...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie cardiovasculaire › Procédures de chirurgie vasculaire › Thrombectomie › Thrombolyse mécanique › Rescue Intracranial Stenting After Failed...
questionsmedicales.fr › Équipement et fournitures › Prothèses et implants › Endoprothèses › Rescue Intracranial Stenting After Failed...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Rescue Intracranial Stenting After Failed...