Abstract Details

Title Emergent Intracranial Rescue Stenting for Acute Ischemic Stroke patients undergoing Thrombectomy with Incomplete Recanalization

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-003

Objective To evaluate the effect of age on outcome of patients who underwent acute rescue intracranial stenting (RIS) after failed endovascular therapy (EVT) compared to those who did not have RIS after failed EVT.

Background The indications for and efficacy of acute rescue intracranial stenting (RIS) in patients undergoing EVT who do not obtain substantial reperfusion remain undetermined.

Design/Methods From our prospectively maintained multi-hospital registry including all patients undergoing EVT, we identified patients with large vessel occlusion (LVO) who underwent EVT resulting in incomplete recanalization (mTICI≤2a) with or without subsequent RIS from January 2017 to June 2021. Primary outcome was defined as probability of severe disability or death (mRS >4), and secondary outcomes included symptomatic intracranial hemorrhage (SICH).

Results Among 65 patients who met inclusion criteria, median age was 69 years [IQR 56-78] and 42% were females. Fifty patients had mTICI≤2a without RIS and 15 underwent acute RIS. Among patients with RIS, TICI≥2b was achieved in 14 (93.3%) after stent deployment. Poor outcome defined as mRS>4 did not statistically differ between groups (RIS vs no RIS, 54.5% vs 48.0%, p=0.69). In multivariable logistic regression adjusted for initial NIHSS, older patients were more likely to have poor outcomes without RIS (OR 4.76 [95% CI 1.24-18.2], p=0.023, age <75 vs age≥75). Rates of SICH was similar in both groups (RIS vs no RIS, 0 vs 2, p=0.43).

Conclusions

In patients undergoing EVT who fail to achieve substantial reperfusion, RIS was associated with decreased likelihood of poor outcomes in older patients. These findings suggest tthat more aggressive revascularization strategies may be warranted in patients with less tolerance for persistent intracranial occlusions.

Authors/Disclosures
Maria A. Parekh, MD (UTHealth Sciences Center at Houston) PRESENTER	Dr. Parekh has nothing to disclose.
Juan Carlos Martinez-Gutierrez, MD (Massachusetts General Hospital, Brigham, Harvard)	No disclosure on file
	No disclosure on file
	No disclosure on file
Rania Abdelkhaleq (UT Health)	No disclosure on file
Arash Niktabe, DO (UTHealth Science Center, McGovern Medical School)	Mr. Niktabe has nothing to disclose.
Youngran Kim	Ms. Kim has nothing to disclose.
Peng R. Chen (University of Texas McGovern Medical School)	Peng R. Chen has nothing to disclose.
Spiros Blackburn	Spiros Blackburn has nothing to disclose.
Gary R. Spiegel, MD (University of Texas Health Science Center At Houston, McGovern Medical Center)	Dr. Spiegel has nothing to disclose.
Sunil Sheth, MD (University of Texas At Houston)	Dr. Sheth has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Penumbra. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imperative Care.

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