title: Stenting as a Rescue Treatment After Failure of Mechanical Thrombectomy for Anterior Circulation Large Artery Occlusion.
abstract: We hypothesized that permanent stenting may be a rescue treatment for stentriever-failed anterior circulation large artery occlusion. We compared the outcomes among patients with permanent stenting and those without stenting after stentriever failure.
  
  
  
  We retrospectively evaluated 208 patients who underwent stentriever thrombectomy for anterior circulation large artery occlusion between September 2010 and September 2015. Modified thrombolysis in cerebral ischemia 2b-3 recanalization was achieved with stentriever alone or in combination with Penumbra device in 155 patients (74.5%). An additional 8 patients (3.8%) obtained modified thrombolysis in cerebral ischemia 2b-3 with urokinase or glycoprotein IIb/IIIa inhibitor infusion. Of the remaining 45 patients (21.6%), 17 underwent stenting (stenting group; mean age, 68 years), whereas 28 did not undergo stenting (nonstenting group; mean age, 72 years). The rate of modified thrombolysis in cerebral ischemia 2b-3 in stenting group was assessed, and clinical outcomes were compared between groups.
  
  
  
  There were no differences in clinical and laboratory findings, initial National Institute of Health Stroke Scale score, location of anterior circulation large artery occlusion, and onset-to-puncture time between groups. Modified thrombolysis in cerebral ischemia 2b-3 was achieved in 14 members (83.3%) of the stenting group. Stenting group had more favorable outcomes (modified Rankin Scale score 0-2, 35.3%) and less cerebral herniation (11.8%) than nonstenting group (modified Rankin Scale score 0-2, 7.1%; cerebral herniation, 42.9%; P<0.05 for both). Symptomatic intracranial hemorrhage and mortality rates did not differ between stenting group (symptomatic intracranial hemorrhage, 11.8%; mortality, 23.5%) and nonstenting group (symptomatic intracranial hemorrhage, 14.3%; mortality, 39.3%).
  
  
  
  Permanent stenting may be a rescue modality for stentriever-failed anterior circulation large artery occlusion. A large prospective study is necessary for confirmation because of the small sample size of this study.
authors.affiliation: From the Department of Neurology, National Medical Center, Seoul, South Korea (J.-H.B.); and Department of Radiology (B.M.K., D.J.K.) and Department of Neurology (J.H.H., H.S.N., J.Y.), Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jang-Hyun
authors.initials: JH
authors.lastname: Baek
authors.affiliation: From the Department of Neurology, National Medical Center, Seoul, South Korea (J.-H.B.); and Department of Radiology (B.M.K., D.J.K.) and Department of Neurology (J.H.H., H.S.N., J.Y.), Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea. bmoon21@hanmail.net.
authors.forename: Byung Moon
authors.initials: BM
authors.lastname: Kim
authors.affiliation: From the Department of Neurology, National Medical Center, Seoul, South Korea (J.-H.B.); and Department of Radiology (B.M.K., D.J.K.) and Department of Neurology (J.H.H., H.S.N., J.Y.), Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: From the Department of Neurology, National Medical Center, Seoul, South Korea (J.-H.B.); and Department of Radiology (B.M.K., D.J.K.) and Department of Neurology (J.H.H., H.S.N., J.Y.), Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
authors.affiliation: From the Department of Neurology, National Medical Center, Seoul, South Korea (J.-H.B.); and Department of Radiology (B.M.K., D.J.K.) and Department of Neurology (J.H.H., H.S.N., J.Y.), Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hyo Suk
authors.initials: HS
authors.lastname: Nam
authors.affiliation: From the Department of Neurology, National Medical Center, Seoul, South Korea (J.-H.B.); and Department of Radiology (B.M.K., D.J.K.) and Department of Neurology (J.H.H., H.S.N., J.Y.), Severance Hospital Stroke Center, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Joonsang
authors.initials: J
authors.lastname: Yoo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D003131:Combined Modality Therapy; D000072226:Computed Tomography Angiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012042:Registries; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator
keywords: stents; stroke; thrombectomy