Please use this identifier to cite or link to this item: https://doi.org/10.1007/s00062-018-0697-x
Title: Intracranial Stenting after Failure of Thrombectomy with the emboTrap® Device
Authors: Cornelissen, S.A
Andersson, T
Holmberg, A
Brouwer, P.A
Söderman, M
Bhogal, P
Yeo, L.L.L 
Keywords: abciximab
acetylsalicylic acid
clopidogrel
prasugrel
aged
antiplatelet activity
Article
blood clot lysis
brain hemorrhage
brain infarction
brain ischemia
clinical outcome
cohort analysis
computed tomographic angiography
core laboratory
demography
drug dose escalation
dual antiplatelet therapy
dual energy computed tomography
female
follow up
human
intermethod comparison
magnetic resonance angiography
major clinical study
male
mechanical thrombectomy
medical record review
National Institutes of Health Stroke Scale
neuroimaging
prospective study
Rankin scale
recanalization
retrospective study
stroke patient
treatment failure
Issue Date: 2019
Citation: Cornelissen, S.A, Andersson, T, Holmberg, A, Brouwer, P.A, Söderman, M, Bhogal, P, Yeo, L.L.L (2019). Intracranial Stenting after Failure of Thrombectomy with the emboTrap® Device. Clinical Neuroradiology 29 (4) : 677-683. ScholarBank@NUS Repository. https://doi.org/10.1007/s00062-018-0697-x
Rights: Attribution 4.0 International
Abstract: Background: Approved alternatives in the guidelines for acute ischemic stroke patients who have failed intracranial thrombectomy are lacking. Primary permanent intracranial stenting was initially used in the era before thrombectomy and might still be a useful rescue treatment in acute stroke patients suffering from ongoing large vessel occlusion refractory to thrombectomy. Methods: The prospectively collected registry of patients with acute stroke caused by large vessel occlusions and treated with the emboTrap® device in Karolinska Hospital from October 2013 through March 2017 were retrospectively reviewed. Clinical outcome of non-recanalized patients with a thrombolysis in cerebral infarction (TICI) score of 0–1 after failed thrombectomy were compared with those who were treated with permanent intracranial stenting as rescue therapy. Favorable outcome was defined as modified Rankin scale 0–2. Results: The emboTrap® device was used in 201 patients. Persistent re-occlusions on withdrawal of the thrombectomy device were seen in 26 patients (13%) and of those, 12 individuals (46%) were treated with intracranial stenting. Baseline National Institutes of Health stroke scale (NIHSS), occlusion site, and onset-to-puncture time did not differ between the stenting group and the non-recanalized group. During the procedure half dose (5/12 patients) or full dose abciximab (6/12 patients), or aspirin (1/12 patient) was given intravenously immediately after stent placement. In 2 patients (17%) multiple stents were implanted. The stenting group had better functional outcomes at 3 months compared to the non-stenting group with 8/12 (66%) vs. 3/14 (21.4%, p?< 0.05). Of the patients 5 (36%) in the non-stented group had died at 3 months follow-up, whereas mortality in the stenting cohort was 0% (p?< 0.05) and no symptomatic intracranial hemorrhage (ICH) occurred in either group. Conclusion: Intracranial stenting after failure of recanalization with thrombectomy led to a better rate of clinical outcome than leaving the patient non-recanalized. The required antiplatelet therapy, predominantly abciximab, did not lead to additional ICH. © 2018, The Author(s).
Source Title: Clinical Neuroradiology
URI: https://scholarbank.nus.edu.sg/handle/10635/178042
ISSN: 18691439
DOI: 10.1007/s00062-018-0697-x
Rights: Attribution 4.0 International
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