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Title: Rescue Intracranial Stenting After Failed Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.
Authors: Maingard, Julian;Phan, Kevin;Lamanna, Anthony;Kok, Hong Kuan;Barras, Christen D;Russell, Jeremy;Hirsch, Joshua A;Chandra, Ronil V;Thijs, Vincent N;Brooks, Duncan Mark;Asadi, Hamed
Affiliation: Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Department of Imaging, Monash University, Melbourne, Victoria, Australia
Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Department of Neurosurgery, Austin Health, Heidelberg, Victoria, Australia
Interventional Neuroradiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, New South Wales, Australia
Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia
School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia
Interventional Radiology Service, Department of Radiology, Northern Hospital, Melbourne, Victoria, Australia
South Australian Institute of Health and Medical Research, Adelaide, South Australia, Australia
School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
Issue Date: Dec-2019
EDate: 2019
Citation: World neurosurgery 2019; 132: e235-e245
Abstract: 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.
DOI: 10.1016/j.wneu.2019.08.192
ORCID: 0000-0003-0705-2252
PubMed URL: 31493593
Type: Journal Article
Systematic Review
Subjects: Acute ischemic stroke
Intracranial atherosclerosis
Appears in Collections:Journal articles

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