• World Neurosurg · Dec 2019

    Meta Analysis

    Rescue intracranial stenting following failed mechanical thrombectomy for acute ischaemic stroke: a systematic review and meta-analysis.

    • Julian Maingard, Kevin Phan, Anthony Lamanna, Hong Kuan Kok, Christen D Barras, Jeremy Russell, Joshua A Hirsch, Ronil V Chandra, Vincent Thijs, Mark Brooks, and Hamed Asadi.
    • Interventional Neuroradiology Unit - Monash Imaging, Monash Health, Melbourne, Victoria, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Victoria, Australia. Electronic address: julian.maingard@gmail.com.
    • World Neurosurg. 2019 Dec 1; 132: e235-e245.

    BackgroundUp to 20% of patients fail to achieve reperfusion with modified Thrombolysis in Cerebral Infarction (mTICI) scores of 0-1 after mechanical thrombectomy (MT). Furthermore, underlying intracranial atherosclerotic disease, particularly when associated with >70% residual or flow limiting stenosis, is associated with higher rates of failed MT and high failure risk MT. The aim of this study was to systematically review the procedural and clinical outcomes in patients with failed MT and high failure risk MT. We also explored differences between patients receiving acute rescue stenting compared with medical management alone.MethodsA systematic literature search was conducted in Ovid MEDLINE, PubMed, Embase, and Cochrane online scientific publication databases for English language publications from their date of inception until October 2018. Studies including adult patients with acute ischemic stroke because of emergent large vessel occlusion with failed (mTICI score 0-1) or high failure risk MT within the anterior circulation who underwent rescue stenting were included. A systematic review and meta-analysis of proportions was performed.ResultsRescue intracranial stenting after failed MT or high failure risk MT results in improved clinical outcomes compared with patients without stenting (48.5% vs. 19.7%, respectively; P < 0.001), without an increase in the rate of symptomatic intracranial hemorrhage, despite additional use of antiplatelet agents (9.7% vs. 14.1%, respectively; P = 0.04).ConclusionsIn patients who fail initial attempts at MT or are high risk for acute reocclusion, rescue intracranial stenting could be considered with the aim to improve functional outcomes. Antiplatelet agents do not increase the risk of hemorrhage in these patients.Copyright © 2019 Elsevier Inc. All rights reserved.

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