Intracranial Rescue Stent Angioplasty After Stent-Retriever Thrombectomy : Multicenter Experience

Clin Neuroradiol. 2019 Sep;29(3):445-457. doi: 10.1007/s00062-018-0690-4. Epub 2018 May 14.

Abstract

Purpose: Stent-retriever thrombectomy (SRT) for acute intracranial large artery occlusion (LAO) may not result in permanent recanalization in rare cases, e.g. due to an underlying stenosis or dissection. In this specific patient group, rescue stent angioplasty (RSA) may be the only treatment option to achieve permanent vessel patency and potentially a good clinical outcome. To date, the experience with RSA is limited.

Methods: In this retrospective analysis, interventional and clinical data of patients with acute intracranial LAO of the anterior and posterior circulation who underwent RSA after SRT due to an underlying lesion between 2012-2017 in four neurovascular centers were studied.

Results: In this study 34 patients (mean age 67 years) were included whereby 18 patients had anterior circulation LAO and 16 patients posterior circulation LAO. The SRT maneuver count ranged between 1 and 15 (median 2). Indications for RSA were an immediate re-occlusion in 25 (74%), and a persistent high-grade stenosis in 9 patients (26%). The RSA was technically feasible in 33 patients (97%). A mTICI 2b/3 result was obtained in 26 patients (76%). Median onset-to-recanalization time was 248 min (range 80-650 min). After 3 months 10/34 patients (29%) had a good clinical outcome (modified Rankin Scale, mRS 0-2). In detail, 4/18 patients (22%) with anterior circulation LAO and 6/16 patients (38%) with posterior circulation LAO were functionally independent.

Conclusion: The use of RSA can be considered for acute intracranial LAO in cases with immediate re-occlusion or high-grade stenosis after SRT alone.

Keywords: Acute intracranial large artery occlusion; Permanent revascularization; Rescue stent angioplasty; Stent-retriever thrombectomy; Underlying vessel lesion.

Publication types

  • Case Reports
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angioplasty / methods*
  • Carotid Stenosis / diagnostic imaging
  • Carotid Stenosis / surgery
  • Cerebral Arterial Diseases / diagnostic imaging
  • Cerebral Arterial Diseases / surgery*
  • Constriction, Pathologic / diagnostic imaging
  • Constriction, Pathologic / surgery
  • Device Removal / methods
  • Endovascular Procedures / instrumentation
  • Endovascular Procedures / methods*
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Infarction, Middle Cerebral Artery / diagnostic imaging
  • Infarction, Middle Cerebral Artery / surgery
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Salvage Therapy / instrumentation
  • Salvage Therapy / methods*
  • Stents*
  • Thrombectomy / methods*
  • Time-to-Treatment
  • Treatment Outcome
  • Vertebrobasilar Insufficiency / diagnostic imaging
  • Vertebrobasilar Insufficiency / surgery

Substances

  • Fibrinolytic Agents