You are here

Article Text

Article menu
Download PDFPDF
Clinical neurology
Original research
Rescue angioplasty and/or stenting after mechanical thrombectomy: who can benefit?
  1. BaiXue Jia1,2,
  2. Longhui Zhang1,
  3. Yuesong Pan1,2,
  4. Xu Tong1,2,
  5. Xuelei Zhang3,
  6. Dapeng Mo1,2,
  7. Ning Ma1,2,
  8. Gang Luo1,2,
  9. Ligang Song1,2,
  10. Xiaoqing Li1,2,
  11. Bo Wang1,2,
  12. Thanh N Nguyen4,
  13. Feng Gao1,2,
  14. Zhongrong Miao1,2
  15. on behalf of ANGEL-ACT Study Group
    1. 1 Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    2. 2 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    3. 3 Stroke Center, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
    4. 4 Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
    1. Correspondence to Dr Zhongrong Miao; zhongrongm{at}163.com; Dr Feng Gao; gaofengletter{at}sina.com

    Abstract

    Background Angioplasty and/or stenting is a rescue therapy for mechanical thrombectomy (MT) in acute intracranial large vessel occlusion. This study was undertaken to determine whether rescue angioplasty and/or stenting improves the outcome after MT and to investigate whether outcomes differ by subgroup of rescue indication.

    Methods We performed propensity score matching (PSM) with data from a prospective multicenter registry of patients with acute large vessel occlusion receiving endovascular treatment. Patients were divided into the MT alone group and the MT with rescue therapy group. The primary outcome was functional independence (modified Rankin Scale score of 0–2) at 90 days. PSM was also performed in the failed MT (modified Thrombolysis In Cerebral Infarction (mTICI) 0–2a) and the residual severe stenosis (mTICI 2b–3) subgroups, respectively.

    Results 326 patients of mean±SD age 62.7±12.0 years (90 women, 27.6%) were matched from 1274 patients. In the matched cohort, functional independence at 90 days was higher in the rescue therapy group than in the MT alone group (44.2% vs 29.5%; OR 1.90, 95% CI 1.18 to 3.06, P=0.008). In the failed MT subgroup with 66 matched pairs, more patients had functional independence in the rescue therapy group than in the MT alone group (39.0% vs 17.0%; OR 3.12, 95% CI 1.29 to 7.59, P=0.01). In the residual stenosis subgroup with 63 matched pairs, functional independence rates were similar in the rescue therapy and the MT alone groups (51.6% vs 55.7%; OR 0.85, 95% CI 0.42 to 1.72, P=0.65).

    Conclusion Rescue angioplasty and/or stenting could improve the clinical outcome in patients with acute large vessel occlusion with failed MT, while no benefit was seen in those with residual severe stenosis but substantial reperfusion.

    • thrombectomy
    • stenosis
    • stent
    • stroke

    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author on reasonable request.

    https://doi.org/10.1136/jnis-2023-020824

    Statistics from Altmetric.com

      Request Permissions

      If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

      Data availability statement

      Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author on reasonable request.

      View Full Text

      Footnotes

      • X @NguyenThanhMD

      • BJ and LZ contributed equally.

      • Collaborators Zhongrong Miao, Beijing Tiantan Hospital, Beijing; Liqiang Gui, Langfang Changzheng Hospital, Hebei; Cunfeng Song, Liaocheng Third People's Hospital, Shandong; Ya Peng, The First People's Hospital of Changzhou, Jiangsu; Jin Wu, The Second Affiliated Hospital of Nanjing Medical University, Jiangsu; Shijun Zhao, Fengrun District People’s Hospital of Tangshan City, Hebei; Junfeng Zhao, SiPing Central People's Hospital, Jilin; Zhiming Zhou, Yijishan Hospital of Wannan Medical College, Anhui; Yongli Li, The 2nd Affiliated Hospital of Harbin Medical University, Heilongjiang; Ping Jing, The Central Hospital of Wuhan, Hubei; Lei Yang, The First Hospital of Shijiazhuang, Hebei; Yajie Liu, Shenzhen Hospital of Southern Medical University, Guangdong; Qingshi Zhao, The People’s Hospital of Longhua, Guangdong; Yan Liu, Jingjiang People's Hospital, Jiangsu; Xiaoxiang Peng, The Third People's Hospital of Hubei Province, Hubei; Qingchun Gao, The Second Affiliated Hospital of Guangzhou Medical University, Guangdong; Zaiyu Guo, Tianjin TEDA Hospital, Tianjin; Wenhuo Chen, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian; Weirong Li, Taiyuan Central Hospital, Shanxi; Xiaojiang Cheng, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang; Yun Xu, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu; Yongqiang Zhang, The First People's Hospital of Wenling, Zhejiang; Guilian Zhang, The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi; Yijiu Lu, The First People's Hospital of Yulin, Guangxi; Xinyu Lu, Zhenjiang First People's Hospital, Jiangsu; Dengxiang Wang, Qitaihe Coal General Hospital Heilongjiang; Yan Wang, People's Hospital of Tangshan City, Hebei; Hao Li, Affiliated Hospital of Guilin Medical University, Guangxi; Yang Hua, The Affiliated Hospital of Guizhou Medical University, Guizhou Province; Deqin Geng, The Affiliated Hospital of Xuzhou Medical University, Jiangsu; Haicheng Yuan, Qingdao Central Hospital, ShanDong; Hongwei Wang, The Fourth People's Hospital of Langfang City, Hebei; Haihua Yang, Beijing Daxing hospital, Beijing; Zengwu Wang, Weifang People's Hospital,ShanDong; Liping Wei, Luoyang General Hospital Affiliated to Zhengzhou University, Henan; Xuancong Liufu, Dongguan Kanghua Hospital, Guangdong; Xiangqun Shi, Shunde Hospital of Southern Medical University, Guangdong; Juntao Li, Handan Central Hospital, Hebei; Wenwu Yang, The 981 hospital of the Chinese People's Liberation Army, Hebei; Wenji Jing, Linfen people’s Hospital, Shanxi; Xiang Yong, Anshun people's Hospital of Guizhou; Leyuan Wang, Changle People's Hospital, Shandong; Chunlei Li, The Second People's Hospital of Dongying, Shandong; Yibin Cao, Tangshan Gongren hospital, HeBei; Qingfeng Zhu, PLA 985th Hospital of the Joint Logistics Support Force, Shanxi; Peng Zhang, Gaomi People's Hospital, ShanDong; Xiang Luo, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei; Shengli Chen, Chongqing Sanxia Center Hospital, Chongqing; WenWu Peng, Hospital of Traditional Chinese Medicine of Qiannan, Guizhou; Lixin Wang, Guangdong Hospital of Chinese Medicine, Guangdong; Xue Wen, People's hospital of Yangjiang, Guangdong; Shugui Shi, The Third Affiliated Hospital of CQMU, Chongqing; Wanming Wang, General Hospital of The Yangtze River Shipping, Hubei; Wang Bo, First People's Hospital of Bijie City,Guizhou; Pu Yuan, Suqian People's Hospital of Nanjing Drum-Tower Hospital Group, Jiangsu; Dong Wang, Weifang TCM Hospital, Shandong; Haitao Guan, The Third Affiliated Hospital of Guangzhou Medical University, Guangdong; Wenbao Liang, Karamay Central hospital, Xinjiang; Daliang Ma, The third people's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang; Long Chen, Wulanchabu City Central Hospital, Inner Mongolia; Yan Xiao, Hospital of Xinjiang Production & Construction Corps, Xinjiang; Xiangdong Xie, Jiaozuo Second people's hospital, Henan; Zhonghua Shi, 904th Hospital of Joint Logistic Support Force of PLA, Jiangsu; Xiangjun Zeng, Ganzhou People's Hospital, Jiangxi; Fanfan Su, 967 Hospital of the Joint Logistics Support Force of PLA, Liaoning; MingZe Chang, The Affiliated Hospital of Northwest University Xi’an No.3 Hospital, Shaanxi; Jijun Yin, The Second Hospital of Liao Cheng, Shandong; Hongxia Sun, Jilin Province People's Hospital, Jilin; Chong Li, People's Hospital of Huanghua City, Hebei; Yong Bi, Shanghai Forth People's Hospital, Shanghai; Gang Xie, Wanbei Coal-electricity Group Gneral Hospital, Anhui; Yuwu Zhao, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai; Chao Wang, Binzhou Medical University Hospital, Shandong; Peng Zhang, The 988 hospital of the people's liberation army, Henan; Xianjun Wang, Linyi People's Hospital, Shandong; Dongqun Li, Yingkou City Central Hospital, Liaoning; Hui Liang, Yantaishan Hospital, Shandong; Zhonglun Chen, Mianyang Central hospital, Sichuan; Yan Wang, Chengdu Fifth People's Hospital, Sichuan; Yu Xin Wang, Hengshui Fifth Hospital of Heng shui City, HeBei; Lin Yin, Second Hospital of Dalian Medical University, Liaoning; HongKai Qiu, Boai Hospital of Zhongshan, Guangdong; Jun Wei, The First People's Hospital of Yibin, Sichuan; Yaxuan Sun, Shanxi provincial people's hospital, Shanxi; Xiaoya Feng, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Shandong; Weihua Wu, Chuxiong State People's Hospital, Chuxiong, Yunnan; Lianbo Gao, The Fourth Affiliated Hospital of China Medical University, Liaoning; Zhibing Ai, Taihe Hospital, Shiyan, Hubei; Tan Lan, Qingdao Municipal Hospital, Shandong; Li Ding, The First People's Hospital of Yunnan Province, Yunnan; Qilong Liang, The NO.2 People’s Hospital of Lanzhou. Gansu; Zhimin Wang, Taizhou First People's Hospital, Zhejiang; Jianwen Yang, Hunan Provincial People's Hospital, Hunan; Ping Xu, First People's Hospital of Changde City, Hunan; Wei Dong, Zhejiang Yuyao People’s Hospital, Zhejiang; Quanle Zheng, AideBao Hospital, HeBei; Zhenyun Zhu, The First Hospital of Fangshan District, Beijing; Liyue Zhao, Tianjin Xiqing Hospital, Tianjin; Qingbo Meng, People's Hospital of Zunhua, Hebei; Yuqing Wei, Xingtai Third Hospital, Hebei; Xianglin Chen, Qingyuan People’s Hospital, Guangdong; Wei Wang, Fengcheng City Central Hospital, Liaoning; Dong Sun, People's Hospital of Hejian City, Hebei; Yongxing Yan, Hangzhou Third People's Hospital, Zhejiang; Guangxiong Yuan, Xiangtan Central Hospital, Hunan; Yadong Yang, People's Hospital of Nanpi Country, Hebei; Jianfeng Zhou, Liuzhou Railway Central Hospital, Guangxi; Zhi Yang, Maoming People's Hospital, Guangdong; Zhenzhong Zhang, Tongde Hospital of Zhejiang Province, Zhejiang; Ning Guan, The First Affiliated Hospital of Jinzhou Medical University, Liaoning; Huihong Wang, Xishan coal electricity group worker general hospital, Shaanxi.

      • Contributors Study concept and design, data acquisition, statistical analyses, interpretation of the data, and drafting the manuscript: BJ and LZ. Major role in data acquisition, interpretation of the data, and critical revision of the manuscript for intellectual content: YP. Critical revision of the manuscript for intellectual content: XT, XZ, DM, NM, GL, LS, XL, BW, TNN, and FG. Study concept and design, interpretation of the data, critical revision of the manuscript for intellectual content: ZM. ZM is the guarantor of the work.

      • Funding This work was supported by National Key R&D Program (2018AAA0102600), Beijing Natural Science Foundation Z220016 and National Natural Science Foundation of China 62272325.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.