Rescue intracranial stenting for failed posterior circulation thrombectomy: analysis from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study.

IF 4.5 1区医学 Q1 NEUROIMAGING Journal of NeuroInterventional Surgery Pub Date : 2024-09-17 DOI:10.1136/jnis-2023-020676

Mahmoud H Mohammaden, Mohamed A Tarek, Hassan Aboul Nour, Diogo C Haussen, Johanna T Fifi, Stavros Matsoukas, Mudassir Farooqui, Santiago Ortega-Gutierrez, Cynthia B Zevallos, Milagros Galecio-Castillo, Ameer E Hassan, Wondwossen Tekle, Alhamza R Al-Bayati, Mohamed M Salem, Jan Karl Burkhardt, Bryan Pukenas, Gustavo M Cortez, Ricardo A Hanel, Amin Aghaebrahim, Eric Sauvageau, Muhammad Hafeez, Peter Kan, Omar Tanweer, Mouhammad Jumaa, Syed F Zaidi, Marion Oliver, Sunil A Sheth, Michael Nahhas, Sergio Salazar-Marioni, Ahmad Khaldi, Hanzhou Li, Okkes Kuybu, Mohamad Abdalkader, Piers Klein, Sophia Peng, Ali Alaraj, Thanh N Nguyen, Raul G Nogueira

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引用次数: 0

Abstract

Backgrounds: Recent trials have shown improved outcomes after mechanical thrombectomy (MT) for vertebrobasilar occlusion (VBO) stroke. However, there is a paucity of data regarding safety and outcomes of rescue intracranial stenting (RS) after failed MT (FRRS+) for posterior circulation stroke. We sought to compare RS to failed reperfusion without RS (FRRS-).

Methods: This is a retrospective analysis of the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study, a multicenter collaboration involving prospectively collected databases. Patients were included if they had posterior circulation stroke and failed MT. The cohort was divided into two groups: FRRS+ and FRRS- (defined as modified Thrombolysis In Cerebral Infarction (mTICI) score 0-2a). The primary outcome was a shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included mRS 0-2 and mRS 0-3 at 90 days. Safety measures included rates of symptomatic intracranial hemorrhage (sICH), procedural complications, and 90-day mortality. Sensitivity and subgroup analyses were performed to identify outcomes in a matched cohort and in those with VBO, respectively.

Results: A total of 152 failed thrombectomies were included in the analysis. FRRS+ (n=84) was associated with increased likelihood of lower disability (acOR 2.24, 95% CI 1.04 to 4.95, P=0.04), higher rates of mRS 0-2 (26.8% vs 12.5%, aOR 4.43, 95% CI 1.22 to 16.05, P=0.02) and mRS 0-3 (35.4% vs 18.8%, aOR 3.13, 95% CI 1.08 to 9.10, P=0.036), and lower mortality (42.7% vs 59.4%, aOR 0.40, 95% CI 0.17 to 0.97, P=0.04) at 90 days compared with FRRS- (n=68). The rates of sICH and procedural complications were comparable between the groups. Sensitivity and subgroup analyses showed similar results.

Conclusion: In patients with posterior circulation stroke who had failed MT, RS resulted in better functional outcomes with comparable safety profile to procedure termination.

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后循环血栓切除术失败后的颅内支架置入抢救：神经血栓切除术中的支架置入和血管成形术（SAINT）研究分析。

背景：最近的试验表明，椎基底动脉闭塞（VBO）卒中机械取栓术（MT）后的疗效有所改善。然而，有关后循环卒中机械取栓失败（FRRS+）后颅内支架植入术（RS）的安全性和疗效的数据却很少。我们试图将 RS 与无 RS 的再灌注失败（FRRS-）进行比较：这是对神经血栓切除术中的支架和血管成形术（SAINT）研究的回顾性分析，该研究是一项多中心合作研究，涉及前瞻性收集的数据库。后循环卒中且 MT 治疗失败的患者被纳入研究。组群分为两组：FRRS+组和FRRS-组（定义为改良脑梗塞溶栓治疗（mTICI）评分0-2a）。主要结果是 90 天后用改良兰金量表（mRS）测量的残疾程度的变化。次要结果包括 90 天后的 mRS 0-2 和 mRS 0-3。安全性指标包括症状性颅内出血（sICH）发生率、手术并发症和90天死亡率。进行了敏感性分析和亚组分析，以分别确定匹配队列和VBO患者的结果：共有 152 例失败的血栓切除术被纳入分析。FRRS+（n=84）与较低的残疾可能性增加（acOR 2.24，95% CI 1.04 至 4.95，P=0.04）、较高的 mRS 0-2 比率（26.8% vs 12.5%，aOR 4.43，95% CI 1.22 至 16.05，P=0.02）和 mRS 0-3（35.4% vs 18.8%，aOR 3.13，95% CI 1.08 至 9.10，P=0.036），90 天死亡率（42.7% vs 59.4%，aOR 0.40，95% CI 0.17 至 0.97，P=0.04）低于 FRRS-（n=68）。两组的 sICH 和手术并发症发生率相当。敏感性和亚组分析结果相似：结论：对于MT失败的后循环卒中患者，RS能带来更好的功能预后，其安全性与终止手术相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of NeuroInterventional Surgery NEUROIMAGING-SURGERY

CiteScore

9.50

自引率

14.60%

发文量

291

审稿时长

4-8 weeks

期刊介绍： The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.