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  • Rescue stenting after failure of endovascular thrombectomy for acute vertebrobasilar artery occlusion: data from the PERSIST registry

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Ischemic stroke
Original research
Rescue stenting after failure of endovascular thrombectomy for acute vertebrobasilar artery occlusion: data from the PERSIST registry
  1. Yanan Lu1,
  2. Zongyi Wu2,
  3. Zi Wang1,
  4. Pan Zhang1,
  5. Feng Zhang1,
  6. Miaomiao Hu1,
  7. Wenya Lan3,
  8. Yong Liang4,
  9. Jilong Yi5,
  10. Wen Sun1
  1. 1 Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
  2. 2 Department of Neurology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, China
  3. 3 Department of Cerebrovascular Disease Treatment Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
  4. 4 Department of Neurology, The First Hospital of Changsha, Changsha, Hunan, China
  5. 5 Department of Neurology, The First People's Hospital of Jingmen, Jingmen, Hubei, China
  1. Correspondence to Dr Wen Sun, Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230052, China; sunwen_medneuro{at}163.com; Jilong Yi, Department of Neurology, The first people's Hospital of Jingmen, Jingmen, Hubei, China; yijilong2018{at}163.com

Abstract

Background Among acute vertebrobasilar artery occlusion (VBAO) patients, successful reperfusion is a strong predictor of favorable outcomes. However, failed reperfusion (FR) with endovascular thrombectomy (EVT) in VBAO was observed to occur in 18–50% of cases. We aim to evaluate the safety and efficacy of rescue stenting (RS) for VBAO after failed EVT.

Methods Patients with VBAO who received EVT were enrolled retrospectively. Propensity score matching was performed as the primary analysis to compare the outcomes between patients with RS and FR. Furthermore, a comparison between using the self-expanding stent (SES) and balloon-mounted stent (BMS) in the RS group was also conducted. The primary and secondary outcomes were defined as a 90-day modified Rankin Scale (mRS) score 0–3, and a 90-day mRS score 0–2, respectively. Safety outcomes included all-cause mortality at 90 days and symptomatic intracranial hemorrhage (sICH).

Results The RS group showed a significantly higher rate of 90-day mRS score 0–3 (46.6% vs 20.7%; adjusted OR (aOR) 5.06, 95% CI 1.88 to 13.59, P=0.001) and a lower rate of 90-day mortality (34.5% vs 55.2%; aOR 0.42, 95% CI 0.23 to 0.90, P=0.026) than the FR group. The rates of 90-day mRS score 0–2 and sICH were not significantly different between the RS group and FR group. There were no differences in all outcomes between SES and BMS groups.

Conclusions RS appeared to be a safe and effective rescue approach in patients with VBAO who failed EVT, and there was no difference between using SES and BMS.

  • Stroke

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2022-019931

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • YL and ZW contributed equally.

    • Contributors The study was conceived by YL, ZW, JY, and WS. YL prepared the initial draft of the manuscript. YL and ZW carried out the statistical analysis. ZW, JY, and WS revised the manuscript. YL and WS are the guarantors. All authors participated in the data collection, analysis, and interpretation. The final version of the manuscript was approved by all authors.

    • Funding The study was supported by grants from Key Research and Development Plan Projects of Anhui Province No 202104j07020049 and the Science and Technology Innovation Program of Hunan Province No 2020SK53008.

    • 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.