Interventional Neuroradiology, Hospital Clínico San Carlos, Calle del Prof Martín Lagos s/n, 28040, Madrid, Spain.
Neurology, Hospital Clínico San Carlos, Calle del Profesor Martín Lagos s/n, 28040, Madrid, Spain.
Neuroradiology. 2020 Nov;62(11):1475-1483. doi: 10.1007/s00234-020-02487-9. Epub 2020 Jun 30.
There is no established rescue treatment in patients with mechanical thrombectomy (MT) failure. Our aim is to analyse whether the use of an intracranial stent improves prognosis in these patients.
Retrospective analysis of a prospective cohort of patients with ischemic stroke due to middle cerebral artery occlusion (MCA) or distal intracranial carotid artery (ICA) occlusion, from September 2009 to April 2019 in our comprehensive stroke care centre. Patients with MT failure were identified and dichotomized into two groups according to whether or not an intracranial stent was implanted. We analysed clinical outcomes in both groups.
There was MT failure in 60 patients (14%) of the 433 with large vessel occlusion in distal ICA and proximal MCA. A stent was placed in 20 of them (33.3%). Compared to patients without rescue stenting, they showed better rates of independence at 3 months (mRS ≤ 2) 45% vs 2.5% (p < 0.001) and lower mortality 15% vs 50% (p = 0.009), maintaining statistical significance after multivariate analysis, without a significant increase of the rate of symptomatic intracranial haemorrhage (p = 0.209).
Placement of an intracranial stent as rescue therapy after MT failure was associated with better clinical outcome without significant increase in haemorrhagic complications. We believe that this procedure should be appraised in these patients.
在机械取栓（MT）失败的患者中，尚无既定的挽救治疗方法。我们的目的是分析颅内支架的使用是否能改善这些患者的预后。
回顾性分析 2009 年 9 月至 2019 年 4 月期间在我们综合卒中治疗中心因大脑中动脉闭塞（MCA）或远端颅内颈内动脉（ICA）闭塞而发生缺血性卒中的前瞻性队列研究中的患者。确定 MT 失败的患者，并根据是否植入颅内支架将其分为两组。我们分析了两组患者的临床结果。
在 433 例远端 ICA 和近端 MCA 大血管闭塞患者中，有 60 例（14%）发生 MT 失败。其中 20 例（33.3%）患者植入了支架。与未进行挽救性支架置入的患者相比，他们在 3 个月时的独立率（mRS≤2）更高，分别为 45%和 2.5%（p<0.001），死亡率更低，分别为 15%和 50%（p=0.009），多变量分析后仍具有统计学意义，且症状性颅内出血发生率无显著增加（p=0.209）。
MT 失败后作为挽救性治疗的颅内支架置入与更好的临床结果相关，且出血并发症无显著增加。我们认为，对于这些患者应评估这种方法。
