Rescue stenting after failure of mechanical thrombectomy in patients with large vessel occlusive stroke

Abstract

Objective To investigate the safety and effectiveness of rescue stenting after failure of mechanical thrombectomy in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). Methods From December 2015 to December 2017, patients with AIS caused by LVO and treated with Solitaire AB stent thrombectomy in the Fifth Central Hospital of Tianjin were enrolled retrospectively. CT scans were performed within 24 h after surgery. Symptomatic intracraninal hemorrhage (sICH) was defined as CT confirmed intracranial hemorrhage and the National Institutes of Health Stroke Scale score increased ≥4. Clinical outcomes were assessed using the modified Rankin Scale at 90 d after onset, and 0 to 2 was defined as good outcome. According to whether to receive rescue stenting or not, the patients were divided into 2 groups. The clinical outcomes and incidence of sICH were compared between the 2 groups. Results A total of 39 patients were enrolled. Among them, 29 (74.3%) were successfully recanalized by mechanical thrombectomy and 10 (25.6%) performed stenting after failure of mechanical thrombectomy. Four (40.0%) in the stenting group and 11 (37.9%) the non-stenting group had good outcomes respectively at 90 d. There was no significant difference (P=1.000). Two patients (20.0%) and 1 patient (3.4%) developed sICH within 24 h after operation in the stenting group and the non-stenting group respectively. There was also no significant difference (P=0.156). Conclusions Rescue stenting can be used as a safe and effective remedy for patients with failure of mechanical thrombectomy. Key words: Stroke; Brain Ischemia; Thrombectomy; Stents; Treatment Outcome