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E-052 Safety and efficacy of stenting post failed thrombectomy: multi-institutional experience
  1. B Daou1,
  2. A Sweid1,
  3. S Koduri1,
  4. P Jabbour2,
  5. A Ringer3,
  6. P Kan4,
  7. G Rajah1,
  8. M Bining5,
  9. A Pandey1
  1. 1Neurosurgery, University of Michigan, Ann Arbor, MI
  2. 2Neurosurgery, Thomas Jefferson University, Philadelphia, PA
  3. 3Neurosurgery, Mayfield Clinic, Cincinnati, OH
  4. 4Neurosurgery, Baylor, Houston, TX
  5. 5Neurosurgery, Drexel, Philadelphia, MI


Introduction Even in the era of stent-retrievers, complete recanalization is often not achieved.

Methods In this multi-institutional effort, we retrospectively evaluated 101 consecutive patients across 6 centers who underwent placement of a self-expanding stent during thrombectomy, either as a rescue strategy for intracranial recanalization or for tandem extracranial/intracranial occlusion. We aimed to evaluate recanalization, complications, clinical outcomes, and antithrombotic regimens in these patients.

Results Occlusive thrombus was located in the internal carotid artery (ICA) in 23.8%, in the middle cerebral artery in 59.4% and in the vertebro-basilar circulation in 16.8% of cases. Indications for stenting included persistent occlusion/failed recanalization in 42.6% of cases, tandem occlusions with proximal flow limiting stenosis in 19.8%, vessel reocclusion after initial recanalization in 14.9%, vessel dissection in 15.8% cases, and underlying intracranial stenosis in 6.9% patients. 48.5% of patients had a stent deployed intracranially, 41.6% of stents were deployed within the extracranial ICA/vertebral artery while 9.9% extended from an extracranial to an 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. Significant in-stent stenosis/thrombosis occurred in 7 cases (6.9%). 54.9% had a favorable mRS score at 90 days (0–3) and 90-day mortality occurred in 15.8%. The primary factor associated with complications was placement of multiple stents (P=0.018). 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.

Abstract E-052 Table 1 Antiplatelet/antithrombotic regimens
Abstract E-052 Table 2 Outcomes following stenting

Conclusion Stent placement as a rescue strategy for thrombectomy failure and for tandem configurations offers a high rate of recanalization and favorable outcome without an increase in the hemorrhage risk regardless of antithrombotic regimen and tPA status.

Disclosures B. Daou: None. A. Sweid: None. S. Koduri: None. P. Jabbour: None. A. Ringer: None. P. Kan: None. G. Rajah: None. M. Bining: None. A. Pandey: None.

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