Stentriever thrombectomy failure: a challenge in stroke management.

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Stentriever thrombectomy failure: a challenge in stroke management.

World Neurosurg. 2017 Mar 24;:

Authors: Baracchini C, Farina F, Soso M, Viaro F, Favaretto S, Palmieri A, Kulyk C, Ballotta E, Nico L, Cester G, Causin F

Abstract
BACKGROUND: and Purpose: Stentriever thrombectomy failure in patients with acute ischemic stroke due to anterior circulation large artery occlusion (LAO) is not a rare event. The purpose of this study was to investigate whether other procedures (tirofiban, permanent stenting) are able to recanalize the occluded vessel and determine a better outcome without increasing mortality and intracranial hemorrhage (ICH) rates.
METHODS: Among 513 patients consecutively admitted with anterior circulation stroke, 109 underwent stentriever thrombectomy. Modified Thrombolysis in Cerebral Ischemia (mTICI) 2b-3 recanalization was achieved in 60 patients (55.0%, group 1). Only 3 of 19 patients (group 2) obtained additional recanalization with intrarterial infusion of tirofiban. The remaining 46 either underwent permanent stenting (n = 23, group 3) or were left non-recanalized (n = 23, group 4). The rate of mTICI 2b-3 and clinical outcomes were analyzed in the different groups.
RESULTS: A successful recanalization (mTICI 2b-3) was achieved in 17 (73.9%) patients of group 3. A significantly better outcome was observed in group 3 (modified Rankin Scale [mRS] 0-2) than in group 4 at 3 months (56.5% vs 17.4%). Symptomatic ICH rates were not different between group 3 and group 4 (4.3% vs 4.3%), while there was a significantly higher mortality rate in group 4 than in group 3 (39.1% vs 4.3%). On multivariate analysis permanent stenting was the only factor independently associated with favorable outcome and mortality rates.
CONCLUSIONS: Permanent stenting might be a feasible solution in patients with acute LAO after stentriever thrombectomy failure.

PMID: 28347898 [PubMed - as supplied by publisher]

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