Rescue Stenting for Failed Mechanical Thrombectomy in Acute Basilar Artery Occlusions: Analysis of the PC-SEARCH Registry.

IF 7.8 1区医学 Q1 CLINICAL NEUROLOGY Stroke Pub Date : 2025-02-01 Epub Date: 2024-11-21 DOI:10.1161/STROKEAHA.124.047694

Santiago Ortega-Gutierrez, Aaron Rodriguez-Calienes, Adam T Mierzwa, Milagros Galecio-Castillo, Mahmoud Dibas, Sami Al Kasab, Ashley Nelson, Ashutosh P Jadhav, Shashvat Desai, Gabor Toth, Anas Alrohimi, Mohamad Abdalkader, Piers Klein, Thanh N Nguyen, Hisham Salahuddin, Aditya Pandey, Sravanthi Koduri, Niraj Vora, Nameer Aladamat, Khaled Gharaibeh, Ehad Afreen, Syed Zaidi, Mouhammad Jumaa

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Abstract

Background: We aimed to investigate whether rescue stenting (RS) following failed mechanical thrombectomy (MT) for acute basilar artery occlusion results in superior functional outcomes and enhanced safety compared with the natural history of failed MT.

Methods: This retrospective cohort study utilized data from the Posterior Circulation Ischemic Stroke Evaluation: Analyzing Radiographic and Intra-Procedural Predictors for Mechanical Thrombectomy registry, encompassing 8 high-volume centers in the United States and covering the period from 2015 to 2021. Patients with basilar artery occlusion who experienced failed MT (modified Thrombolysis in Cerebral Infarction score of 0-2a after at least 1 attempt of clot retrieval) were categorized based on whether they received additional intervention with RS. The primary outcome was a shift analysis of the 90-day modified Rankin Scale. Multivariable logistic regression was used to assess both efficacy and safety outcomes.

Results: Of a total of 444 patients, 119 presented failed MT and were included in the analysis. The RS group comprised 65 (14.6%) patients, while the control group consisted of 54 (12.2%) patients. After adjusting, the RS group showed a favorable shift in the overall 90-day modified Rankin Scale distribution (adjusted common odds ratio, 4.56 [95% CI, 1.67-12.45]; P=0.003) and higher rates of 90-day 0 to 3 modified Rankin Scale score (RS: 44.6% versus control: 18.5%; adjusted odds ratio, 7.57 [95% CI, 1.91-30.12]; P=0.004) compared with the control group. RS also showed lower rates of 90-day mortality (RS: 43.1% versus control: 64.8%; adjusted odds ratio, 0.27 [95% CI, 0.09-0.80]; P=0.018) and comparable rates of symptomatic intracranial hemorrhage (RS: 3.1% versus control: 13%; adjusted odds ratio, 0.31 [95% CI, 0.05-1.95]; P=0.214).

Conclusions: Our study demonstrated that RS is associated with improved functional outcomes and reduced mortality in basilar artery occlusion patients presenting MT failure. Further randomized trials are needed to validate these findings.

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急性基底动脉闭塞症机械取栓失败后的支架置入救治：PC-SEARCH登记分析。

背景：我们的目的是研究急性基底动脉闭塞（BAO）机械取栓术（MT）失败后，与机械取栓术（MT）失败的自然病史相比，抢救性支架置入术（RS）是否会带来更好的功能预后和更高的安全性：这项回顾性队列研究利用了PC-SEARCH注册中心的数据，该注册中心包括美国的8个高容量中心，涵盖时间为2015年至2021年。根据是否接受 RS 的额外干预，对 MT 失败的 BAO 患者（至少尝试过一次血块取出后 mTICI 评分为 0-2a）进行分类。主要结果是对 90 天 mRS 进行移位分析。采用多变量逻辑回归评估疗效和安全性结果：在总共 444 名患者中，有 119 名 MT 治疗失败的患者被纳入分析。RS组有65名患者（14.6%），而对照组有54名患者（12.2%）。调整后，与对照组相比，RS 组的 90 天 mRS 整体分布出现了有利的变化（acOR=4.56；95% CI 1.67-12.45；p=0.003），90 天 0-3 mRS 的比例更高（RS：44.6% 对对照组：18.5%，aOR=7.57；95% CI 1.91-30.12；p=0.004）。RS组的90天死亡率也低于对照组（RS组：43.1% vs. 对照组：64.8%，aOR=0.27；95% CI 0.09-0.80；p=0.018），sICH发生率与对照组相当（RS组：3.1% vs. 对照组：13%，aOR=0.31；95% CI 0.05-1.95；p=0.214）：我们的研究表明，对于出现 MT 功能衰竭的 BAO 患者，RS 可改善其功能预后并降低死亡率。需要进一步的随机试验来验证这些发现。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.