Intracranial Stenting as Rescue Therapy After Failure of Mechanical Thrombectomy for Basilar Artery Occlusion: Data From the ANGEL-ACT Registry

Luo, Gang; Gao, Feng; Zhang, Xuelei; Jia, Baixue; Huo, Xiaochuan; Liu, Raynald; Sum, Man; Ma, Gaoting; Peng, Guangge; Zhang, Jingyu; Qi, Zhongqi; Guo, Xu; Han, Bin; Tong, Xu; Wang, Bo; Song, Ligang; Lian, Liu; He, ZJ; Mo, Dapeng; Ma, Ning; Sun, Xuan; Yang, Ming; Miao, Zhongrong

doi:10.3389/fneur.2021.739213

Cited by 26 publications

(15 citation statements)

References 33 publications

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“…Our study showed that the successful recanalization (TICI 2b-3) rate of patients with LVO treated with MT was above 94%. The lower futile recanalization rate in our study compared to that in the HERMES study ( 2 ) (45.2 vs. 54.0%, respectively) may be attributed to the different periods in which the two studies were conducted (2017 vs. 2014), considering the advances in surgical devices and change in choice of surgical procedures [enhanced rescue treatment may improve neurological outcomes ( 23 )]. Our study demonstrated similar 30-day mortality (13.3 vs. 15.3%, respectively) and sICH (4.4 vs. 4.4%, respectively) to the HERMES study.…”

Section: Discussionmentioning

confidence: 55%

Association between blood pressure variability and clinical outcomes after successful recanalization in patients with large vessel occlusion stroke after mechanical thrombectomy

Shen

Lin

et al. 2022

Front. Neurol.

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ObjectiveNearly half of patients who undergo mechanical thrombectomy (MT) do not experience a favorable outcome. The association between blood pressure fluctuation and clinical outcomes after successful MT is controversial. We evaluated the influence of blood pressure variability (BPV) on the clinical outcomes of stroke patients with large vessel occlusion (LVO) who underwent successful recanalization after MT.MethodsPatients with anterior circulation LVO stroke who underwent successful emergency MT (modified Thrombolysis in Cerebral Infarction, mTICI ≥ 2b) at the Shanghai Tenth People's Hospital of Tongji University from 2017 to 2021 were enrolled. Multivariate logistic models were used to investigate the association between BPV (mean arterial pressure [MAP] assessed using the standard deviation [SD]) and clinical outcomes. The primary outcome was 90-day modified Rankin Scale scores (mRS), and the secondary outcomes were 30-day mortality and symptomatic intracranial hemorrhage (sICH).ResultsA total of 458 patients (56.8% men), with a mean age of 72 ± 1 years, were enrolled. Among them, 207 (45.2%) patients had unfavorable functional outcomes (mRS score 3–6) at 90 days, 61 (13.3%) patients died within 30 days, and 20 (4.4%) patients had sICH. In a fully adjusted model, BPV was associated with a higher risk of a 90-day mRS score of 3–6 (P = 0.04), 30-day mortality (P < 0.01), and sICH (P < 0.01). A significant interaction between MAP SD and rescue futile recanalization treatment was observed (P < 0.01).ConclusionsAmong patients with LVO stroke who underwent successful recanalization, higher BPV was associated with worse functional outcomes, especially in those who underwent rescue treatment.

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Section: Discussionmentioning

confidence: 55%

Association between blood pressure variability and clinical outcomes after successful recanalization in patients with large vessel occlusion stroke after mechanical thrombectomy

Shen

Lin

et al. 2022

Front. Neurol.

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“…37 Angioplasty with or without stenting has been demonstrated to prevent unsuccessful EVT in patients after the failure of another technique. 41,42 In 1 retrospective study of patients who underwent EVT for BAO, angioplasty prevented treatment failure in 65 of 188 successfully reperfused patients. 16 Most neurointerventionalists (91.0%) surveyed were willing to proceed to angioplasty or stenting in the case of persistent occlusion due to ICAD.…”

Section: Discussionmentioning

confidence: 99%

Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns

Klein

Herning

Drumm

et al. 2023

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BACKGROUND Two recent trials demonstrated a benefit for endovascular therapy (EVT) in the treatment of basilar artery occlusion (BAO). In light of the expected increase in the use of EVT for BAO, we sought to understand the technique preferences of neurointerventionalists performing EVT for BAO. METHODS We conducted an international online survey of physician opinions on the use of EVT in BAO between January and March 2022. The survey was distributed through stroke and neurointerventional organizations. Survey questions examined selection of patients for the procedure and the techniques currently used for EVT in BAO. Responses from neurointerventionalists were analyzed. RESULTS More than 3000 participants were invited yielding 1245 respondents, of whom 543 were classified as neurointerventionalists across 52 countries and included in this analysis. Most neurointerventionalists would proceed to EVT for occlusions of the V4 segment, the basilar artery, or the posterior cerebral artery, without regard for prior intravenous thrombolysis. For BAO of embolic etiology, aspiration only thrombectomy was the preferred method of 50.3% of neurointerventionalists. For BAO of intracranial atherosclerotic disease etiology, combined stent retriever and aspiration thrombectomy was the preferred method of 40.5% of neurointerventionalists. The majority of neurointerventionalists (88.0%) would proceed to stenting after 3 or fewer failed passes for patients with BAO of intracranial atherosclerotic disease etiology. In patients undergoing stenting, aspirin and clopidogrel was the most common antiplatelet regime (52.4%). CONCLUSIONS Among the surveyed neurointerventionalists, the most common techniques for EVT of patients with BAO were contact aspiration or combined stent retriever with aspiration thrombectomy. For patients with BAO due to intracranial atherosclerotic disease, the majority of neurointerventionalists were willing to stent and do so most often after 3 or fewer failed passes and with the use of dual antiplatelet medications. Further study is needed to determine the optimal technique for EVT of BAO with or without intracranial atherosclerotic disease. Key Words

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“…Recently, Luo et al reported prospective registry data on rescue therapy for acute BAO [58]. In a cohort of 93 patients who failed EVT, 81 (87.1%) received rescue therapy with a 92.6% recanalization rate.…”

Section: Rescue Therapymentioning

confidence: 99%

“…Therefore, rescue therapy should be considered in patients with underlying atherosclerotic stenosis to improve outcome after EVT [26,55,57,58].…”

Section: Rescue Therapymentioning

confidence: 99%

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: Latest Findings and Critical Thinking on Future Study Design

Higashida

2022

Transl. Stroke Res.

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Randomized controlled trials (RCTs) have demonstrated powerful efficacy of endovascular thrombectomy (EVT) for large vessel occlusion in the anterior circulation. The effect of EVT for acute basilar artery occlusion (BAO) in the posterior circulation remains unproven. Here, we highlight the latest findings of observational studies and RCTs of EVT for BAO, with a focus on the predictors of functional outcomes, the limitations of recent RCTs, and critical thinking on future study design. Pooled data from large retrospective studies showed 36.4% favorable outcome at 3 months and 4.6% symptomatic intracranial hemorrhage (sICH). Multivariate logistic regression analysis revealed that higher baseline NIHSS score, pc-ASPECTS < 8, extensive baseline infarction, large pontine infarct, and sICH were independent predictors of poor outcome. Two recent randomized trial BEST (Endovascular treatment vs. standard medical treatment for vertebrobasilar artery occlusion) and BASICS (Basilar Artery International Cooperation Study) failed to demonstrate significant benefit of EVT within 6 or 8 h after stroke symptom onset. The limitations of these studies include slow enrollment, selection bias, high crossover rate, and inclusion of patients with mild deficit. To improve enrollment and minimize risk of diluting the overall treatment effect, futile recanalization and re-occlusion, optimal inclusion/exclusion criteria, including enrollment within 24 h of last known well, NIHSS score ≥ 10, pc-ASPECTS ≥ 8, no large pontine infarct, and the use of rescue therapy for underlying atherosclerotic stenosis, should be considered for future clinical trials.

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Intracranial Stenting as Rescue Therapy After Failure of Mechanical Thrombectomy for Basilar Artery Occlusion: Data From the ANGEL-ACT Registry

Cited by 26 publications

References 33 publications

Association between blood pressure variability and clinical outcomes after successful recanalization in patients with large vessel occlusion stroke after mechanical thrombectomy

Association between blood pressure variability and clinical outcomes after successful recanalization in patients with large vessel occlusion stroke after mechanical thrombectomy

Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns

Endovascular Thrombectomy for Acute Basilar Artery Occlusion: Latest Findings and Critical Thinking on Future Study Design

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