TY - JOUR
T1 - Outcomes of rescue endovascular treatment of emergent large vessel occlusion in patients with underlying intracranial atherosclerosis
T2 - Insights from star
AU - Al Kasab, Sami
AU - Almallouhi, Eyad
AU - Alawieh, Ali
AU - Wolfe, Stacey
AU - Fargen, Kyle M.
AU - Arthur, Adam S.
AU - Goyal, Nitin
AU - Dumont, Travis
AU - Kan, Peter
AU - Kim, Joon Tae
AU - De Leacy, Reade
AU - Maier, Ilko
AU - Osbun, Joshua
AU - Rai, Ansaar
AU - Jabbour, Pascal
AU - Grossberg, Jonathan A.
AU - Park, Min S.
AU - Starke, Robert M.
AU - Crosa, Roberto
AU - Spiotta, Alejandro M.
N1 - Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021/6/15
Y1 - 2021/6/15
N2 - BACKGROUND: Some emergent large vessel occlusions (ELVOs) are refractory to reperfusion because of underlying intracranial atherosclerosis (ICAS), often requiring rescue therapy (RT) with balloon angioplasty, stenting, or both. In this study, we investigate the safety, efficacy, and long-term outcomes of RT in the setting of mechanical thrombectomy for ICAS-related ELVO. METHODS AND RESULTS: We queried the databases of 10 thrombectomy-capable centers in North America and Europe included in STAR (Stroke Thrombectomy and Aneurysm Registry). Patients with ELVO who underwent ICAS-related RT were included. A matched sample was produced for variables of age, admission National Institute of Health Stroke Scale, Alberta Stroke Program Early CT Score, onset to groin puncture time, occlusion site, and final recanalization. Out of 3025 patients with MT, 182 (6%) patients required RT because of underlying ICAS. Balloon angioplasty was performed on 122 patients, and 117 patients had intracranial stenting. In the matched analysis, 141 patients who received RT matched to a similar number of controls. The number of thrombectomy passes was higher (3 versus 1, P<0.001), and procedural time was longer in the RT group (52 minutes versus 36 minutes, P=0.004). There was a higher rate of symptomatic hemorrhagic transformation in the RT group (7.8% versus 4.3%, P=0.211), however, the difference was not significant. There was no difference in 90-day modified Rankin scale of 0 to 2 (44% versus 47.5%, P=0.543) between patients in the RT and control groups. CONCLUSIONS: In patients with ELVO with underlying ICAS requiring RT, despite longer procedure time and a more thrombec-tomy passes, the 90 days favorable outcomes were comparable with patients with embolic ELVO.
AB - BACKGROUND: Some emergent large vessel occlusions (ELVOs) are refractory to reperfusion because of underlying intracranial atherosclerosis (ICAS), often requiring rescue therapy (RT) with balloon angioplasty, stenting, or both. In this study, we investigate the safety, efficacy, and long-term outcomes of RT in the setting of mechanical thrombectomy for ICAS-related ELVO. METHODS AND RESULTS: We queried the databases of 10 thrombectomy-capable centers in North America and Europe included in STAR (Stroke Thrombectomy and Aneurysm Registry). Patients with ELVO who underwent ICAS-related RT were included. A matched sample was produced for variables of age, admission National Institute of Health Stroke Scale, Alberta Stroke Program Early CT Score, onset to groin puncture time, occlusion site, and final recanalization. Out of 3025 patients with MT, 182 (6%) patients required RT because of underlying ICAS. Balloon angioplasty was performed on 122 patients, and 117 patients had intracranial stenting. In the matched analysis, 141 patients who received RT matched to a similar number of controls. The number of thrombectomy passes was higher (3 versus 1, P<0.001), and procedural time was longer in the RT group (52 minutes versus 36 minutes, P=0.004). There was a higher rate of symptomatic hemorrhagic transformation in the RT group (7.8% versus 4.3%, P=0.211), however, the difference was not significant. There was no difference in 90-day modified Rankin scale of 0 to 2 (44% versus 47.5%, P=0.543) between patients in the RT and control groups. CONCLUSIONS: In patients with ELVO with underlying ICAS requiring RT, despite longer procedure time and a more thrombec-tomy passes, the 90 days favorable outcomes were comparable with patients with embolic ELVO.
KW - Acute stroke
KW - Balloon angioplasty
KW - Intracranial atherosclerosis
KW - Mechanical thrombectomy
KW - Rescue therapy
KW - Stenting
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U2 - 10.1161/JAHA.120.020195
DO - 10.1161/JAHA.120.020195
M3 - Article
C2 - 34096337
AN - SCOPUS:85108303707
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 12
M1 - e020195
ER -