TY - JOUR
T1 - Rescue Stenting for Failed Mechanical Thrombectomy in Acute Basilar Artery Occlusions
T2 - Analysis of the PC-SEARCH Registry
AU - Ortega-Gutierrez, Santiago
AU - Rodriguez-Calienes, Aaron
AU - Mierzwa, Adam T.
AU - Galecio-Castillo, Milagros
AU - Dibas, Mahmoud
AU - Al Kasab, Sami
AU - Nelson, Ashley
AU - Jadhav, Ashutosh P.
AU - Desai, Shashvat
AU - Toth, Gabor
AU - Alrohimi, Anas
AU - Abdalkader, Mohamad
AU - Klein, Piers
AU - Nguyen, Thanh N.
AU - Salahuddin, Hisham
AU - Pandey, Aditya
AU - Koduri, Sravanthi
AU - Vora, Niraj
AU - Aladamat, Nameer
AU - Gharaibeh, Khaled
AU - Afreen, Ehad
AU - Zaidi, Syed
AU - Jumaa, Mouhammad
N1 - Publisher Copyright:
© 2024 American Heart Association, Inc.
PY - 2025/2/1
Y1 - 2025/2/1
N2 - BACKGROUND: We aimed to investigate whether rescue stenting (RS) following failed mechanical thrombectomy (MT) for acute basilar artery occlusion results in superior functional outcomes and enhanced safety compared with the natural history of failed MT. METHODS: This retrospective cohort study utilized data from the Posterior Circulation Ischemic Stroke Evaluation: Analyzing Radiographic and Intra-Procedural Predictors for Mechanical Thrombectomy registry, encompassing 8 high-volume centers in the United States and covering the period from 2015 to 2021. Patients with basilar artery occlusion who experienced failed MT (modified Thrombolysis in Cerebral Infarction score of 0-2a after at least 1 attempt of clot retrieval) were categorized based on whether they received additional intervention with RS. The primary outcome was a shift analysis of the 90-day modified Rankin Scale. Multivariable logistic regression was used to assess both efficacy and safety outcomes. RESULTS: Of a total of 444 patients, 119 presented failed MT and were included in the analysis. The RS group comprised 65 (14.6%) patients, while the control group consisted of 54 (12.2%) patients. After adjusting, the RS group showed a favorable shift in the overall 90-day modified Rankin Scale distribution (adjusted common odds ratio, 4.56 [95% CI, 1.67-12.45]; P=0.003) and higher rates of 90-day 0 to 3 modified Rankin Scale score (RS: 44.6% versus control: 18.5%; adjusted odds ratio, 7.57 [95% CI, 1.91-30.12]; P=0.004) compared with the control group. RS also showed lower rates of 90-day mortality (RS: 43.1% versus control: 64.8%; adjusted odds ratio, 0.27 [95% CI, 0.09-0.80]; P=0.018) and comparable rates of symptomatic intracranial hemorrhage (RS: 3.1% versus control: 13%; adjusted odds ratio, 0.31 [95% CI, 0.05-1.95]; P=0.214). CONCLUSIONS: Our study demonstrated that RS is associated with improved functional outcomes and reduced mortality in basilar artery occlusion patients presenting MT failure. Further randomized trials are needed to validate these findings.
AB - BACKGROUND: We aimed to investigate whether rescue stenting (RS) following failed mechanical thrombectomy (MT) for acute basilar artery occlusion results in superior functional outcomes and enhanced safety compared with the natural history of failed MT. METHODS: This retrospective cohort study utilized data from the Posterior Circulation Ischemic Stroke Evaluation: Analyzing Radiographic and Intra-Procedural Predictors for Mechanical Thrombectomy registry, encompassing 8 high-volume centers in the United States and covering the period from 2015 to 2021. Patients with basilar artery occlusion who experienced failed MT (modified Thrombolysis in Cerebral Infarction score of 0-2a after at least 1 attempt of clot retrieval) were categorized based on whether they received additional intervention with RS. The primary outcome was a shift analysis of the 90-day modified Rankin Scale. Multivariable logistic regression was used to assess both efficacy and safety outcomes. RESULTS: Of a total of 444 patients, 119 presented failed MT and were included in the analysis. The RS group comprised 65 (14.6%) patients, while the control group consisted of 54 (12.2%) patients. After adjusting, the RS group showed a favorable shift in the overall 90-day modified Rankin Scale distribution (adjusted common odds ratio, 4.56 [95% CI, 1.67-12.45]; P=0.003) and higher rates of 90-day 0 to 3 modified Rankin Scale score (RS: 44.6% versus control: 18.5%; adjusted odds ratio, 7.57 [95% CI, 1.91-30.12]; P=0.004) compared with the control group. RS also showed lower rates of 90-day mortality (RS: 43.1% versus control: 64.8%; adjusted odds ratio, 0.27 [95% CI, 0.09-0.80]; P=0.018) and comparable rates of symptomatic intracranial hemorrhage (RS: 3.1% versus control: 13%; adjusted odds ratio, 0.31 [95% CI, 0.05-1.95]; P=0.214). CONCLUSIONS: Our study demonstrated that RS is associated with improved functional outcomes and reduced mortality in basilar artery occlusion patients presenting MT failure. Further randomized trials are needed to validate these findings.
KW - basilar artery
KW - cerebral infarction
KW - intracranial hemorrhages
KW - retrospective studies
KW - thrombosis
UR - http://www.scopus.com/inward/record.url?scp=85216983924&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.124.047694
DO - 10.1161/STROKEAHA.124.047694
M3 - Artículo
C2 - 39571537
AN - SCOPUS:85216983924
SN - 0039-2499
VL - 56
SP - 401
EP - 412
JO - Stroke
JF - Stroke
IS - 2
ER -