Intracranial stents in the endovascular treatment of acute ischemic stroke.
OBJECTIVE
To evaluate the efficacy and safety of intracranial stenting as a rescue therapy after failed mechanical thrombectomy in patients with acute ischemic stroke.


METHODS
We retrospectively studied 42 patients treated with intracranial stenting after failed mechanical thrombectomy between December 2008 and January 2016. We compared outcomes before and after the incorporation of stentrievers. We assessed the degree of recanalization in the carotid and basilar territories (modified TIMI score), prognostic factors, and outcome (modified Rankin Score at 3 months). Safety was evaluated in function of the appearance of symptomatic intracranial hemorrhage (SICH).


RESULTS
Median NIHSS was 17 in patients with carotid territory strokes and 26 in those with vertebrobasilar territory strokes. Median time from onset of symptoms to treatment was 225minutes in carotid territory strokes and 390minutes in vertebrobasilar territory strokes. A total of 10 patients underwent intravenous fibrinolytic therapy before treatment with stentrievers. Two patients developed SICH; both had undergone intravenous fibrinolytic therapy (p=0.0523). Recanalization was effective in 30 (71.4%) in the entire series: in 7 (50%) of 14 patients treated before the incorporation of stentrievers and in 23 (82.1%) of 28 treated after the incorporation of stentrievers (p=0.0666). Outcome at 3 months was good in 2 (14.3%) patients in the earlier group and in 14 (50%) patients in the later group (p=0.042). We found significant associations between recanalization and outcome (p=0.0415) and between shorter time to treatment and outcome (p=0.002). Outcome was good in 14 (48.3%) of the 29 patients with carotid territory strokes and in 2 (15.4%) of the 13 patients with vertebrobasilar territory strokes (p=0.078).


CONCLUSIONS
Intracranial stenting is the rescue treatment when the usual treatment fails. Stentrievers must be used to eliminate the clot burden before stenting. In our study, antiplatelet treatment did not seem to increase the risk of SICH except in patients with prior intravenous fibrinolytic treatment.
Servicio de Radiología, Hospital Reina Sofía de Córdoba, España. Electronic address: fdelgado.neuro@gmail.com.
F
F
Delgado Acosta
Servicio de Radiología, Hospital Reina Sofía de Córdoba, España.
E
E
Jiménez Gómez
Servicio de Radiología, Hospital Reina Sofía de Córdoba, España.
I
I
Bravo Rey
Servicio de Neurología, Hospital Reina Sofía de Córdoba, España.
F A
FA
Bravo Rodríguez
Servicio de Neurología, Hospital Reina Sofía de Córdoba, España.
J J
JJ
Ochoa Sepúlveda
Servicio de Radiología, Hospital Reina Sofía de Córdoba, España.
R
R
Oteros Fernández
D000368:Aged; D002545:Brain Ischemia / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000601:surgery*; D016896:Treatment Outcome
Infarto cerebral; Ischemic cerebral stroke; Stents; Thrombectomy; Tratamiento; Treatment; Trombectomía