Angioplasty, stenting, or both - rescue maneuvers and reperfusion after endovascular therapy for intracranial atherosclerosis-related occlusion.

Male Humans Aged Retrospective Studies Endovascular Procedures Treatment Outcome Angioplasty Stroke / surgery Hemorrhage Thrombectomy Intracranial Hemorrhages Stents Intracranial Arteriosclerosis / diagnostic imaging Reperfusion

Angioplasty Intracranial atherosclerosis Outcome Reperfusion Rescue Stenting Stroke Thrombectomy

Journal

Neuroradiology

ISSN: 1432-1920

Titre abrégé: Neuroradiology

Pays: Germany

ID NLM: 1302751

Informations de publication

Date de publication:
Apr 2023

Historique:

received: 18 10 2022

accepted: 18 12 2022

pubmed: 8 1 2023

medline: 25 3 2023

entrez: 7 1 2023

Statut: ppublish

Résumé

Data concerning reperfusion strategies of intracranial atherosclerosis-related occlusion (ICARO) and clinico-angiographic outcomes remain scarce, particularly in Caucasians. We aim to compare the reperfusion rate and functional outcome between reperfusion strategies in the setting of the ICARO. Retrospective analysis of prospectively maintained endovascular thrombectomy (EVT) registries at three high-volume stroke centers were retrospectively analyzed for consecutive ICARO patients from January 2015 to December 2019. We defined ICARO as any fixed high-degree (> 70%) focal narrowing or stenosis of any degree with a perpetual tendency for reocclusion. We categorized reperfusion strategies into four groups: EVT [group 1], balloon angioplasty [(BAp), group 2], placement of self-expandable stents [(SES), group 3], and BAp combined with implantation of SES; or direct placement of balloon mounted stents (BMS) [(BAp-SES/BMS), group 4]. We evaluated the association with the successful reperfusion [mTICI 2b - 3] and favorable outcome [mRS 0-2] with logistic regression analysis. Out of 2550 EVT, 124 patients (median age, 70 (61-80) years; 76 men) with ICARO and 130 reperfusion attempts [36 EVT, 38 BAp, 17 SES, and 39 BAp + SES/BMS] were analyzed. SES implantation showed the highest frequency of post-procedural symptomatic intracranial hemorrhage [(18%, 3/17), p = .03]; however, we observed no significant differences in the mortality rate. Overall, we achieved successful reperfusion in 71% (92/130) and favorable outcomes in 42% (52/124) of the patients. BAp + SES/BMS was the only independent predictor of the final successful reperfusion [aOR, 4.488 (95% CI, 1.364-14.773); p = .01], which was significantly associated with the 90-day favorable outcome [aOR, 10.837 (95% CI, 3.609-32.541); p = < .001] after adjustment for confounding variables between the reperfusion strategies. Among patients with ICARO, the rescue angioplasty stenting effectively contributed to higher odds of successful reperfusion with no increased risk for intracranial hemorrhage.

Identifiants

DOI: 10.1007/s00234-022-03108-3 PMID: 36609714

pubmed: 36609714

doi: 10.1007/s00234-022-03108-3

pii: 10.1007/s00234-022-03108-3

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

775-784

Investigateurs

Mohamed Abdelrady (M)

Imad Derraz (I)

Pierre-Henri Lefevre (PH)

Federico Cagnazzo (F)

José Rodriguez (J)

Eduardo Murias (E)

Juan Chaviano (J)

José Maria Jimenez (JM)

Carlos Riquelme (C)

Gregory Gascou (G)

Lucas Corti (L)

Nicolas Gaillard (N)

Mourad Cheddad El Aouni (MC)

Douraied Ben Salem (DB)

Cyril Dargazanli (C)

Julien Ognard (J)

Isabelle Mourand (I)

Caroline Arquizan (C)

Jean-Christophe Gentric (JC)

Pedro Vega (P)

Vincent Costalat (V)

Informations de copyright

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