Sajja Kalyan Chakravarthy, Huded Vikram, Prajapati Chintan, Male Shailesh, Sharma Mukesh Kumar, Shah Shirpal, Bohra Vikram, Chakravarthi Sudheer, Prasanna Lakshmi Sudha, Sura Pradeep Reddy, Paramasivam Srinivasan, Gorijala Vamsi Krishna, Guntamukkala Anusha, Somasundaram Kumarvelu, Vemuri Rama Tharaknath
Endovascular Neurosurgery, Thomas Jefferson University, Willow Grove, USA.
Neuroscience, Narayana Health City Hospital, Bangalore, IND.
Cureus. 2022 Apr 5;14(4):e23847. doi: 10.7759/cureus.23847. eCollection 2022 Apr.
Failed mechanical thrombectomy due to a refractory emergent large vessel occlusion (RELVO) in patients presenting with an acute stroke poses a major challenge to the outcomes.
We demonstrate the use of coronary stents in the intracranial circulation as rescue stenting for an already expensive mechanical thrombectomy procedure in a mid-low socioeconomic setting.
A retrospective, multicenter study was conducted between December 2015 and January 2021. The studied cohort were patients who required the use of a rescue stenting using a coronary stent for emergent large vessel occlusion to avoid failed recanalization. Failed recanalization was defined as failed vessel recanalization after at least two passes. Patient demographic data, procedure specifics, type of stent used, and procedural outcomes were collected.
A total of 26 patients with acute ischemic stroke were included from eight different centers across India. Out of 26 patients, 19 (73.0%) were male and seven were female (26.9%). The mean age was 53.6 years, the youngest patient was 23 years old and the eldest was 68 years old. Seven patients (26.9%) had posterior circulation stroke due to occlusion of the vertebral or basilar artery and 19 patients (73.0%) had anterior circulation stroke median NIHSS at presentation was 16 (range 10 to 28) in anterior circulation stroke and 24 (range 16 to 30) in posterior circulation stroke. Intravenous thrombolysis with tissue plasminogen activator (IV tPA) was given in three patients (11.5%). The hospital course of two patients was complicated by symptomatic intracranial hemorrhage (sICH), which was fatal. Favorable revascularization outcome and favorable functional outcome was achieved in 22 patients (84.6%), three patients passed away (11.5%), and one patient was lost to follow up.
Overall, our study finds that rescue stenting using coronary stents can potentially improve outcomes in refractory large vessel occlusions while minimizing costs in low-mid economic settings.
急性卒中患者因难治性急性大血管闭塞（RELVO）导致机械取栓失败对治疗结果构成重大挑战。
我们展示了在中低社会经济背景下，将冠状动脉支架用于颅内循环作为对已成本高昂的机械取栓手术的补救支架置入术。
于2015年12月至2021年1月进行了一项回顾性多中心研究。研究队列是那些因急性大血管闭塞需要使用冠状动脉支架进行补救支架置入术以避免再通失败的患者。再通失败定义为至少两次尝试后血管再通失败。收集了患者人口统计学数据、手术细节、使用的支架类型和手术结果。
印度八个不同中心共纳入26例急性缺血性卒中患者。26例患者中，19例（73.0%）为男性，7例为女性（26.9%）。平均年龄为53.6岁，最年轻的患者23岁，最年长的68岁。7例患者（26.9%）因椎动脉或基底动脉闭塞发生后循环卒中，19例患者（73.0%）发生前循环卒中。前循环卒中患者就诊时美国国立卫生研究院卒中量表（NIHSS）中位数为16（范围10至28），后循环卒中患者为24（范围16至30）。3例患者（11.5%）接受了组织纤溶酶原激活剂静脉溶栓（IV tPA）。2例患者的住院过程出现症状性颅内出血（sICH），并导致死亡。22例患者（84.6%）实现了良好的血管再通结果和良好的功能结果，3例患者死亡（11.5%），1例患者失访。
总体而言，我们的研究发现，使用冠状动脉支架进行补救支架置入术有可能改善难治性大血管闭塞的治疗结果，同时在中低经济背景下将成本降至最低。
