Universität zu Köln

Stracke, Christian Paul, Fiehler, Jens, Meyer, Lukas ORCID: 0000-0002-3776-638X, Thomalla, Goetz, Krause, Lars Udo, Lowens, Stephan, Rothaupt, Jan, Kim, Byung Moon ORCID: 0000-0001-8593-6841, Heo, Ji Hoe ORCID: 0000-0001-9898-3321, Yeo, Leonard L. L., Andersson, Tommy, Kabbasch, Christoph, Dorn, Franziska, Chapot, Rene and Hanning, Uta ORCID: 0000-0002-7543-8555 (2020). Emergency Intracranial Stenting in Acute Stroke: Predictors for Poor Outcome and for Complications. J. Am. Heart Assoc., 9 (5). HOBOKEN: WILEY. ISSN 2047-9980

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Abstract

Background Stent-retriever thrombectomy is the first-line therapy in acute stroke with intracranial large vessel occlusion. In case of failure of stent-retriever thrombectomy, rescue stent angioplasty might be the only treatment option to achieve permanent recanalization. This study aims at identifying predictors for poor outcome and complications in a large, multicenter cohort receiving rescue stent angioplasty. Methods and Results We performed a retrospective analysis of patients with large vessel occlusion who were treated with rescue stent angioplasty after stent-retriever thrombectomy between 2012 and 2018 in 7 neurovascular centers. We defined 2 binary outcomes: (1) functional clinical outcome (good modified Rankin Scale, 0-2; and poor modified Rankin Scale, 4-6) and (2) early symptomatic intracerebral hemorrhage. Impacts of clinical, radiological, and interventional parameters on outcomewere assessed in uni- and multivariable logistic regression models. Two hundred ten patients were included with target vessels located within the anterior circulation (136 of 210; 64.8%) and posterior circulation (74 of 210; 35.2%). Symptomatic intracerebral hemorrhage occured in 22 patients, 86.4% (19 of 22) after anterior and 13.6% (3 of 22) after posterior circulation large vessel occlusion. Good functional outcome was observed in 44.8% (73 of 163). A higher National Institutes of Health Stroke Scale on admission (adjusted odds ratio, 1.10; P=0.002), a higher premorbid modified Rankin Scale (adjusted odds ratio, 2.02; P=0.049), and a modified Thrombolysis in Cerebral Infarction score of 0 to 2a after stenting (adjusted odds ratio, 23.24; P<0.001) were independent predictors of poor functional outcome. Conclusions Use of rescue stent angioplasty can be considered for acute intracranial large vessel occlusion in cases after unsuccessful stent-retriever thrombectomy. Likelihood of symptomatic intracerebral hemorrhage is higher in anterior circulation stroke.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Stracke, Christian Paul UNSPECIFIED UNSPECIFIED UNSPECIFIED Fiehler, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Meyer, Lukas UNSPECIFIED orcid.org/0000-0002-3776-638X UNSPECIFIED Thomalla, Goetz UNSPECIFIED UNSPECIFIED UNSPECIFIED Krause, Lars Udo UNSPECIFIED UNSPECIFIED UNSPECIFIED Lowens, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Rothaupt, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Kim, Byung Moon UNSPECIFIED orcid.org/0000-0001-8593-6841 UNSPECIFIED Heo, Ji Hoe UNSPECIFIED orcid.org/0000-0001-9898-3321 UNSPECIFIED Yeo, Leonard L. L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Andersson, Tommy UNSPECIFIED UNSPECIFIED UNSPECIFIED Kabbasch, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Dorn, Franziska UNSPECIFIED UNSPECIFIED UNSPECIFIED Chapot, Rene UNSPECIFIED UNSPECIFIED UNSPECIFIED Hanning, Uta UNSPECIFIED orcid.org/0000-0002-7543-8555 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-341500
DOI:	10.1161/JAHA.119.012795
Journal or Publication Title:	J. Am. Heart Assoc.
Volume:	9
Number:	5
Date:	2020
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	2047-9980
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACUTE ISCHEMIC-STROKE; MECHANICAL THROMBECTOMY; ENDOVASCULAR TREATMENT; ARTERY-OCCLUSION; RESCUE TREATMENT; STENOSIS; THERAPY; RECOMMENDATIONS; ANGIOPLASTY; REOCCLUSION Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34150