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  • E-100 Rescue therapy with self-expandable stenting versus medical therapy after failed mechanical thrombectomy for acute large vessel occlusion stroke: a systematic review and meta-analysis

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SNIS 20th annual meeting electronic poster abstracts
E-100 Rescue therapy with self-expandable stenting versus medical therapy after failed mechanical thrombectomy for acute large vessel occlusion stroke: a systematic review and meta-analysis
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  1. J Sequeiros1,
  2. F Terry2,
  3. S Graham3,
  4. N Pacheco4,
  5. M Padilla5,
  6. H Zaver3,
  7. C Quispe6,
  8. C Cruzalegui6,
  9. F Chavez7,
  10. M Pascual6,
  11. C Alva8,
  12. V Inoa9,
  13. D Hoit10,
  14. A Arthur10,
  15. N Goyal9
  1. 1Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
  2. 2Facultad de Medicina Humana, Universidad de San Martin de Porres, Lima, Peru
  3. 3University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA
  4. 4Alberto Hurtado School of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
  5. 5Sociedad Científica Huachana de Estudiantes de Medicina, Escuela de Medicina Humana de la Universidad Nacional José Faustino Sánchez Carrión, Lima, Peru
  6. 6Sociedad Cientifica de San Fernando, Universidad Nacional Mayor de San Marcos, Facultad de Medicina., Lima, Peru
  7. 7Sociedad Cientifica de Estudiantes de Medicina de Ica, Universidad Nacional San Luis Gonzaga, Ica, Ica, Peru
  8. 8Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú., Lima, Peru
  9. 9Neurology, University of Tennessee Health Science Center and Semmes Murphey Clinic, Memphis, TN, USA
  10. 10Neurosurgery, University of Tennessee Health Science Center and Semmes Murphey Clinic, Memphis, TN, USA

Abstract

Introduction Retrospective studies have demonstrated that rescue stenting is associated with better functional outcome compared with allowing continued inadequate reperfusion in patients with large vessel stroke. Self-expandable stents (SES) can be used to achieve reperfusion with the potential risks of sICH from reperfusion or perforation. Limited data are available to evaluate this strategy. In this meta-analysis, we assess the effectiveness and safety of rescue therapy with self-expandable stents (SES) in patients who failed mechanical thrombectomy after acute large vessel occlusion stroke.

Methods Our systematic review used PRISMA guidelines to report the search results. Searches were conducted using the PubMed/Medline, Scopus, Embase, and Cochrane databases up to September 2022, including randomized clinical trials (RCT) and observational studies which clearly compared rescue stenting with SES versus standard medical management. The primary outcome of interest was functional independence, defined as modified Rankin Scale score (mRS): 0-2. Secondary safety outcomes were 90 days mortality, and symptomatic intracranial hemorrhage (sICH). We performed a meta-analysis using the random effect model using the Mantel-Haenszel method to calculate odds ratio (OR) and 95% confidence intervals (CI) for each outcome. Heterogeneity was evaluated using the I^2 and considered high if over 70%.

Results Seven studies (n=710) were included in this systematic review. Of the patients in these studies, 209 (29.4%) received rescue stenting with SES and 501 (70.5%) received standard medical management. Stents used in the included studies were the Wingspan, Neuroform, Solitaire AB, Enterprise, Acclino, and Atlas. We were not able to perform a subgropus analysis based on type of stents. Baseline characteristics were similar in both groups. All patients who underwent rescue stenting achieved successful reperfusion.Pooled analysis showed that patients who received rescue therapy with SES presented a higher proportion of functional independence 46.41%, 95% CI [36.53-56.43] (I2 = 46.86%) compared with standard management 25.7%, 95%CI [7.93-48.74] (I^2 = 96.14%). Chances to achieve functional independence was higher on the SES group: RR: 1.38 95% CI [1.13-1.68] (I^2 = 81.6%) p< 0.01. Mortality at 90 days was lower on the rescue therapy with SES group (RR = 0.68; 95% CI 0.46 - 0.99; p=0.002) with substantial heterogeneity (I^2 = 77.0%). Symptomatic ICH was similar in both groups (RR = 1.15; 95% CI 0.71- 1.86; p=0.693) with substantial heterogeneity (I^2 = 0.0%). Six of the seven studies presented serious risk of bias.

Conclusion Our study showed that, when compared to patients treated with best medical management, patients who received rescue therapy with SES after failed mechanical thrombectomy had a higher chances of functional independence, with lower mortality and similar sICH. However due to serious risk of bias and significant heterogeneity in the studies included, randomized trials using a standard technique and independently adjudicated outcomes are needed to confirm our results.

Disclosures J. Sequeiros: None. F. Terry: None. S. Graham: None. N. Pacheco: None. M. Padilla: None. H. Zaver: None. C. Quispe: None. C. Cruzalegui: None. F. Chavez: None. M. Pascual: None. C. Alva: None. V. Inoa: None. D. Hoit: None. A. Arthur: None. N. Goyal: None.

https://doi.org/10.1136/jnis-2023-SNIS.200

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