1. Outcomes of Rescue Endovascular Treatment of Emergent Large Vessel Occlusion in Patients With Underlying Intracranial Atherosclerosis: Insights From STAR
- Author
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Sami Al Kasab, Eyad Almallouhi, Ali Alawieh, Stacey Wolfe, Kyle M. Fargen, Adam S. Arthur, Nitin Goyal, Travis Dumont, Peter Kan, Joon‐Tae Kim, Reade De Leacy, Ilko Maier, Joshua Osbun, Ansaar Rai, Pascal Jabbour, Jonathan A. Grossberg, Min S. Park, Robert M. Starke, Roberto Crosa, Alejandro M. Spiotta, Jonathan R. Lena, Reda Chalhoub, Mohammad El‐Ghanem, Dileep R. Yavagal, Eric C. Peterson, Daniel Raper, Patrick A. Brown, Louis J. Kim, Melanie Walker, Daniel Alan Hoit, Violiza Inoa‐Acosta, Christopher Nickele, Lucas Elijovich, Fernanda Rodriguez‐Erazú, Jan Lima, Alex Brehm, and Kimberly Kicielinski
- Subjects
Male ,Time Factors ,Databases, Factual ,Large vessel ,intracranial atherosclerosis ,030204 cardiovascular system & hematology ,Balloon ,0302 clinical medicine ,Risk Factors ,balloon angioplasty ,Medicine ,Registries ,Thrombectomy ,Original Research ,Aged, 80 and over ,Stenosis ,Middle Aged ,Intracranial Arteriosclerosis ,3. Good health ,Europe ,Stroke ,Treatment Outcome ,Cardiology ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,acute stroke ,stenting ,Risk Assessment ,mechanical thrombectomy ,03 medical and health sciences ,Refractory ,Rescue therapy ,Internal medicine ,Humans ,In patient ,Endovascular treatment ,Aged ,Ischemic Stroke ,Retrospective Studies ,business.industry ,Recovery of Function ,rescue therapy ,Functional Status ,North America ,Cerebrovascular Disease/Stroke ,Intracranial Atherosclerosis ,business ,Angioplasty, Balloon ,030217 neurology & neurosurgery ,Large vessel occlusion - Abstract
Background Some emergent large vessel occlusions (ELVOs) are refractory to reperfusion because of underlying intracranial atherosclerosis (ICAS), often requiring rescue therapy (RT) with balloon angioplasty, stenting, or both. In this study, we investigate the safety, efficacy, and long‐term outcomes of RT in the setting of mechanical thrombectomy for ICAS‐related ELVO. Methods and Results We queried the databases of 10 thrombectomy‐capable centers in North America and Europe included in STAR (Stroke Thrombectomy and Aneurysm Registry). Patients with ELVO who underwent ICAS‐related RT were included. A matched sample was produced for variables of age, admission National Institute of Health Stroke Scale, Alberta Stroke Program Early CT Score, onset to groin puncture time, occlusion site, and final recanalization. Out of 3025 patients with MT, 182 (6%) patients required RT because of underlying ICAS. Balloon angioplasty was performed on 122 patients, and 117 patients had intracranial stenting. In the matched analysis, 141 patients who received RT matched to a similar number of controls. The number of thrombectomy passes was higher (3 versus 1, P P =0.004). There was a higher rate of symptomatic hemorrhagic transformation in the RT group (7.8% versus 4.3%, P =0.211), however, the difference was not significant. There was no difference in 90‐day modified Rankin scale of 0 to 2 (44% versus 47.5%, P =0.543) between patients in the RT and control groups. Conclusions In patients with ELVO with underlying ICAS requiring RT, despite longer procedure time and a more thrombectomy passes, the 90 days favorable outcomes were comparable with patients with embolic ELVO.
- Published
- 2021