Abstract
Stent Placement in Mechanical Thrombectomy for Acute Ischemic Stroke: A Multi-Institutional Experience
Neurosurgery, v 67(Supplement_1)
Dec 2020
Abstract
Abstract
INTRODUCTION
Even in the era of stent-retrievers, complete recanalization is often not achieved in about 20% of cases.
METHODS
101 consecutive patients across 6 centers who underwent placement of a self-expanding stent during thrombectomy were evaluated. We aimed to assess recanalization, complications, clinical outcome, and antithrombotic regimens.
RESULTS
Indications for stenting included persistent occlusion/failed recanalization in 42.6% of cases, tandem occlusions in 19.8%, vessel reocclusion after initial recanalization in 14.9%, vessel dissection in 15.8% cases, and underlying intracranial stenosis in 6.9% of patients. Stents were deployed intracranially in 48.5% of patients, 41.6% of stents were deployed within the extracranial internal carotid (ICA)/vertebral artery, while 9.9% involved an extracranial and intracranial vascular segment. Multiple stents were deployed in 9.9% of cases. Successful recanalization (TICI 2b/3) was obtained in 91.1% following stenting. Symptomatic intracranial hemorrhage occurred in 13 patients (12.9%), only two of which had received tPA. In-stent stenosis/thrombosis occurred in 6.9%. 54.9% had an mRS 0–3 at 90 days and mortality occurred in 15.8%. The main factor associated with complications was placement of multiple stents (P = .018). 71.3% of patients were loaded with antiplatelet agents intraoperatively prior to stent placement, most commonly with Aspirin/Plavix ± eptifibatide or Tirofiban, followed by maintenance on dual antiplatelet treatment. There were no significant differences in outcomes between different antithrombotic regimens.
CONCLUSION
Stent placement when needed for failed thrombectomy cases, dissections or for tandem configurations, offers a high rate of recanalization which may lead to improved patient outcomes, without an increase in the hemorrhage risk.
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Details
- Title
- Stent Placement in Mechanical Thrombectomy for Acute Ischemic Stroke: A Multi-Institutional Experience
- Creators
- Badih Junior DaouAhmad SweidPascal JabbourJoseph GemmeteNeeraj ChaudharyByron G ThompsonGary B RajahAdnan H SiddiquiAndrew J RingerPeter KanMandy J BinningAditya S Pandey
- Publication Details
- Neurosurgery, v 67(Supplement_1)
- Publisher
- Oxford University Press
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- Neurology
- Other Identifier
- 991021918101504721