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SNIS 20th annual meeting electronic poster abstracts
E-248 Rescue intracranial stenting for failed posterior circulation thrombectomy: analysis from saint study
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  1. M Mohammaden1,
  2. M Tarek1,
  3. D Haussen1,
  4. J Fifi2,
  5. S Matsoukas2,
  6. M Farooqui3,
  7. S Ortega-Gutierrez3,
  8. C Zevallos3,
  9. M Galecio-Castillo3,
  10. A Hassan4,
  11. W Tekle4,
  12. A Al-Bayati5,
  13. M Salem6,
  14. J Burkhardt6,
  15. B Pukenas6,
  16. G Cortez7,
  17. R Hanel7,
  18. A Aghaebrahim7,
  19. E Sauvageau7,
  20. M Hafeez8,
  21. P Kan8,
  22. O Tanweer8,
  23. M Jumaa9,
  24. S Zaidi9,
  25. M Oliver9,
  26. S Sheth10,
  27. M Nahhas10,
  28. S Salazar-Marioni10,
  29. A Khaldi11,
  30. H Li11,
  31. O Kuybu5,
  32. M Abdalkader12,
  33. P Klein13,
  34. S Peng14,
  35. A Alaraj14,
  36. T Nguyen13,
  37. R Nogueira5
  1. 1Neurology, Emory university/Grady Memorial Hospital, atlanta, GA, USA
  2. 2Department of Neurology, Icahn School of Medicine at Mount Sina, New York, NY, USA
  3. 3Neurology, University of Iowa Hospitals and Clinics, Iowa, IA, USA
  4. 4Neurology, Valley Baptist Medical Center, Harlingen, TX, USA
  5. 5Neurology, UPMC, Pittsburgh, PA, USA
  6. 6Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
  7. 7Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, FL, USA
  8. 8Neurosurgery, Baylor School of Medicine, Houston, TX, USA
  9. 9Neurology, University of Toledo, Toledo, OH, USA
  10. 10Neurology, University of Texas, Houston, TX, USA
  11. 11Neurosurgery, WellStar Health System, atlanta, GA, USA
  12. 12Radiology, Boston University School of Medicine, Boston, MA, USA
  13. 13Neurology, Boston University School of Medicine, Boston, MA, USA
  14. 14Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA

Abstract

Introduction and Purpose Recent trials have shown improved outcomes after mechanical thrombectomy for basilar artery occlusion stroke. However, there is no sufficient data regarding safety and efficacy of rescue stenting (RS) after failed thrombectomy in posterior circulation strokes. We sought to compare RS to failed reperfusion (FR) who did not undergo RS.

Materials and Methods It is a retrospective analysis of prospectively collected database from Stenting and Angioplasty in NeuroThrombectomy (SAINT) study. Patients were included if they had posterior circulation stroke due to vertebrobasilar or posterior cerebral artery occlusion stroke and failed mechanical thrombectomy. The cohort was divided into two groups (1) RS and (2) FR defined as modified Thrombolysis in Cerebral Ischemia score 0-2a. The primary outcome was the shift in the degree of disability as measured by modified Rankin Scale (mRS) at 90-days. Secondary outcomes included 90-day mRS0-2 and 90-day mRS0-3. Safety measures included rates of symptomatic intracranial hemorrhage (sICH), procedural complications and 90-day mortality. Sensitivity analysis was performed to balance the two groups in a 1:1 match considering age, site of occlusion, gender, presence of atrial fibrillation, initial blood glucose level, time from last known normal to puncture and baseline national institute of health stroke scale (NIHSS) score. Additionally, subgroup analysis was conducted to identify outcomes in those with vertebrobasilar occlusions.

Results A total of 152 failed thrombectomies were included in the analysis. RS (n=84) group was younger (63.6±12.6 vs. 69.7±13.5 years, P=0.005), less females (21.4% vs. 51.5%, P<0.001), more Hispanic (26.2% vs. 7.4%, P=0.03), lower rates of atrial fibrillation (6% vs. 33.8%, P<0.002), higher rates of IV-Aggrastat use (22.6% vs. 7.4%, P=0.01) and more vertebrobasilar occlusions (92.9% vs. 67.6%, P<0.001) compared to FR group (n=68). The median NIHSS score, pc-ASPECTS and time form LNK to puncture, and rates of IV-tPA administration were similar among both groups (table 1). RS was associated with increased likelihood of lower disability (mRS ordinal shift, aCOR 2.24, 95%CI [1.04-4.95], P=0.04, higher rates of mRS0-2 (26.8% vs. 12.5%, P=0.03, aOR 4.43, 95%CI [1.22-16.05], P=0.02), mRS0-3 (35.4% vs. 18.8%, P=0.027, aOR 3.13, 95%CI [1.08-9.10], P=0.036) and lower rates of mortality at 90-days (42.7% vs. 59.4%, P=0.045, aOR 0.40, 95%CI [0.17-0.97], P=0.04) compared to FR group. The rates of sICH and procedural complications were comparable among both groups. Similarly, sensitivity and subgroups analyses demonstrated better outcomes with comparable safety in those who underwent RS compared to FR group.

Conclusion In patients with posterior circulation occlusion stokes who failed mechanical thrombectomy, our study suggests that RS has better outcomes with comparable safety profile. Randomized controlled studies are warranted for more concrete evidence.

View this table:
Abstract E-248 Table 1

Baseline demographic, clinical and procedural characteristics among rescue stenting and failed reperfusion groups

Disclosures M. Mohammaden: None. M. Tarek: None. D. Haussen: None. J. Fifi: None. S. Matsoukas: None. M. Farooqui: None. S. Ortega-Gutierrez: None. C. Zevallos: None. M. Galecio-Castillo: None. A. Hassan: None. W. Tekle: None. A. Al-Bayati: None. M. Salem: None. J. Burkhardt: None. B. Pukenas: None. G. Cortez: None. R. Hanel: None. A. Aghaebrahim: None. E. Sauvageau: None. M. Hafeez: None. P. Kan: None. O. Tanweer: None. M. Jumaa: None. S. Zaidi: None. M. Oliver: None. S. Sheth: None. M. Nahhas: None. S. Salazar-Marioni: None. A. Khaldi: None. H. Li: None. O. Kuybu: None. M. Abdalkader: None. P. Klein: None. S. Peng: None. A. Alaraj: None. T. Nguyen: None. R. Nogueira: None.

https://doi.org/10.1136/jnis-2023-SNIS.347

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