Stent-Retriever Thrombectomy and Rescue Treatment of M1 Occlusions Due to Underlying Intracranial Atherosclerotic Stenosis: Cohort Analysis and Review of the Literature.

Dobrocky, Tomas; Kaesmacher, Johannes; Bellwald, Sebastian; Piechowiak, Eike Immo; Mosimann, Pascal John; Zibold, Felix; Jung, Simon; Arnold, Marcel; Fischer, Urs; Gralla, Jan; Mordasini, Pasquale (2019). Stent-Retriever Thrombectomy and Rescue Treatment of M1 Occlusions Due to Underlying Intracranial Atherosclerotic Stenosis: Cohort Analysis and Review of the Literature. Cardiovascular and interventional radiology, 42(6), pp. 863-872. Springer 10.1007/s00270-019-02187-9

[img] Text
Stent-Retriever M1 atherosclerotic.pdf - Published Version
Restricted to registered users only until 12 March 2023.
Available under License Publisher holds Copyright.

Download (524kB) | Request a copy

BACKGROUND AND PURPOSE Data on the management of large vessel occlusion in patients with anterior circulation acute ischemic stroke (AIS) due to underlying intracranial stenosis are scarce. The aim of this retrospective study was to compare endovascular treatment and outcome in AIS patients with and without underlying stenosis of the M1 segment. MATERIALS AND METHODS A total of 533 acute stroke patients with an isolated M1 occlusion who underwent mechanical thrombectomy between 02/2010 and 08/2017 were included. Underlying intracranial atherosclerotic stenosis (ICAS) was present in 10 patients (1.9%), whereas 523 patients (98.1%) had an embolic occlusion without stenosis. RESULTS There was no difference in age, admission National Institutes of Health Stroke Scale, risk factors, Alberta stroke program early CT score or collaterals between the groups. Procedure time (155 vs 40 min, P = 0.001) was significantly longer in the ICAS group where rescue stent-angioplasty was performed in all patients. There was no statistical difference in final modified thrombolysis in cerebral infarction score between both groups (70 vs 88%, P = 0.115). Favorable outcome (modified Rankin Scale ≤ 2) at 90 days was less frequent in patients with ICAS than in the embolic group (0 vs 49.4%, P = 0.004). The mortality rate tended to be higher in the ICAS group (44.4 vs 19.4%, P = 0.082). CONCLUSION In patients with AIS, rescue therapy with stent placement to treat underlying ICAS of the M1 segment is technically feasible; however, in our study, a significantly lower rate of favorable outcome was observed in these patients compared to those with thromboembolic M1 occlusions. LEVEL OF EVIDENCE Level 3, non-randomized controlled study.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Dobrocky, Tomas; Kaesmacher, Johannes; Bellwald, Sebastian; Piechowiak, Eike Immo; Mosimann, Pascal John; Zibold, Felix; Jung, Simon; Arnold, Marcel; Fischer, Urs; Gralla, Jan and Mordasini, Pasquale

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1432-086X

Publisher:

Springer

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

09 May 2019 14:13

Last Modified:

25 Oct 2019 01:54

Publisher DOI:

10.1007/s00270-019-02187-9

PubMed ID:

30859286

Uncontrolled Keywords:

Acute ischemic stroke Intracranial stenosis Intracranial stenting M1 occlusion Thrombectomy

BORIS DOI:

10.7892/boris.127943

URI:

https://boris.unibe.ch/id/eprint/127943

Actions (login required)

Edit item Edit item
Provide Feedback