Hyperacute Stenting for Acute Ischemic Stroke Is Associated with a High Rate of Symptomatic Intracranial Hemorrhage (P02.200)

Abstract

Objective: To report the safety of acute stent placement in patients with acute ischemic stroke. Background Patients with large vessel occlusions often fail to recanalize with intravenous rt-PA or standard endovascular techniques. Small series have reported excellent recanalization rates with acute stenting. However, its safety is not well known. Design/Methods: We retrospectively reviewed charts of twenty-four consecutive patients treated with stents for large artery occlusions. All eligible patients received intravenous rt-PA before proceeding to endovascular treatment. If there was contraindication to its usage or no neurological improvement occurred after its infusion, the patient underwent immediate angiographic evaluation and treatment. Outcomes were based upon disposition and in-hospital mortality. Results: Twenty-four patients had twenty-seven stents deployed in three scenarios: 1. initial therapy (n=3), 2. after the usage of intra-arterial rt-PA and/or angioplasty (n=19) or 3. as a salvage therapy (n=4). Fourteen patients (58%) received IV rt-PA. The arterial occlusion sites included 11 (44%) proximal M1 middle cerebral artery, 10 (40%) internal carotid artery (8 intracranial, 2 extracranial and 3 involving both), 3 (16%) basilar artery and 1 (4%) vertebral artery. Stents were successfully deployed in 24 out of 27 cases (89%) Poor discharge outcomes were defined as death (n=7), hospice (n=2) or skilled nursing facility (n=5) and occurred in 58% of patients. Good outcomes included home discharge (n=1), inpatient rehabilitation (n=7) or long term acute care facility (n=2) for a total of 42%. The causes attributed to poor outcomes were secondary to either symptomatic intracerebral hemorrhage (sICH) or stroke progression. Five (21%) patients had sICH where any ICH was seen in 14 (58%) total patients. Conclusions: Our results indicate that the usage of acute stentings in ischemic stroke is associated with a high rate of sICH and its routine use is not recommended. Prospective studies regarding the utility and benefits of stents are warranted. Disclosure: Dr. Fong has nothing to disclose. Dr. Bershad has nothing to disclose. Dr. Morsi has nothing to disclose. Dr. Shaltoni has nothing to disclose. Dr. Mawad has nothing to disclose. Dr. Georgiadis has nothing to disclose. Dr. Suarez has received personal compensation for activities with Bristol-Myers Squibb/Sanofi and Boehringer Ingelheim as a speaker. Dr. Suarez has received research support from the Haas Trust and NINDS. Dr. Venkatasubba Rao has nothing to disclose.