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Clinical Neuroradiology
Published in: Clinical Neuroradiology 4/2019

Open Access 01-12-2019 | Original Article

Intracranial Stenting after Failure of Thrombectomy with the emboTrap® Device

Authors: Sandra A. Cornelissen, Tommy Andersson, Ake Holmberg, Patrick A. Brouwer, Michael Söderman, Pervinder Bhogal, Leonard L. L. Yeo

Published in: Clinical Neuroradiology | Issue 4/2019

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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.
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Literature
1.
Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372:2296–306.CrossRef
2.
Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t‑PA vs. t‑PA alone in stroke. N Engl J Med. 2015;372:2285–95.CrossRef
3.
Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–30.CrossRef
4.
Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20.CrossRef
5.
Baek JH, Kim BM, Kim DJ, Heo JH, Nam HS, Yoo J. Stenting as a rescue treatment after failure of mechanical thrombectomy for anterior circulation large artery occlusion. Stroke. 2016;47:2360–3.CrossRef
6.
Levy EI, Mehta R, Gupta R, Hanel RA, Chamczuk AJ, Fiorella D, et al. Self-expanding stents for recanalization of acute cerebrovascular occlusions. AJNR Am J Neuroradiol. 2007;28:816–22.PubMed
7.
Zaidat OO, Wolfe T, Hussain SI, Lynch JR, Gupta R, Delap J, et al. Interventional acute ischemic stroke therapy with intracranial self-expanding stent. Stroke. 2008;39:2392–5.CrossRef
8.
Brekenfeld C, Schroth G, Mattle HP, Do DD, Remonda L, Mordasini P, et al. Stent placement in acute cerebral artery occlusion: use of a self-expandable intracranial stent for acute stroke treatment. Stroke. 2009;40:847–52.CrossRef
9.
Sung SM, Lee TH, Lee SW, Cho HJ, Park KH, Jung DS. Emergent intracranial stenting for acute M2 occlusion of middle cerebral artery. Clin Neurol Neurosurg. 2014;119:110–5.CrossRef
10.
Dumont TM, Natarajan SK, Eller JL, Mocco J, Kelly WH Jr, Snyder KV, et al. Primary stenting for acute ischemic stroke using the Enterprise vascular reconstruction device: early results. J Neurointerv Surg. 2014;6:363–72.CrossRefPubMed
11.
Kulcsár Z, Bonvin C, Lovblad KO, Gory B, Yilmaz H, Sztajzel R, Rufenacht D. Use of the enterprise™ intracranial stent for revascularization of large vessel occlusions in acute stroke. Clin Neuroradiol. 2010;20:54–60.CrossRef
12.
Sugiura Y, Yamagami H, Sakai N, Yoshimura S, Committee of Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan Study Group. Predictors of symptomatic intracranial hemorrhage after endovascular therapy in acute ischemic stroke with large vessel occlusion. J Stroke Cerebrovasc Dis. 2017;26:766–71.CrossRef
13.
Yoo AJ, Simonsen CZ, Prabhakaran S, Chaudhry ZA, Issa MA, Fugate JE, et al. Cerebral Angiographic Revascularization Grading Collaborators. Refining angio-graphic biomarkers of revascularization: improving outcome pre-diction after intra-arterial therapy. Stroke. 2013;44:2509–12.CrossRef
14.
Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317–29.CrossRef
15.
Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, et al.. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012;380:1231–40.CrossRef
16.
Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, et al. Solitaire flow restoration device versus the Merci retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 2012;380:1241–9.CrossRef
17.
Baracchini C, Farina F, Soso M, Viaro F, Favaretto S, Palmieri A, et al. Stentriever thrombectomy failure: a challenge in stroke management. World Neurosurg. 2017;103:57-64.CrossRefPubMed
18.
Albuquerque FC, Levy EI, Turk AS, Niemann DB, Aagaard-Kienitz B, Pride GL Jr, et al. Angiographic patterns of Wingspan in-stent restenosis. Neurosurgery. 2008;63:23–8.CrossRef
19.
Bose A, Hartmann M, Henkes H, Liu HM, Teng MM, Szikora I, et al. A novel, self-expanding, nitinol stent in medically refractory intracranial atherosclerotic stenoses: the Wingspan study. Stroke. 2007;38:1531–7.CrossRef
20.
Fiorella DJ, Levy EI, Turk AS, Albuquerque FC, Pride GL Jr, Woo HH, et al. Target lesion revascularization after wingspan: assessment of safety and durability. Stroke. 2009;40:106–10.CrossRef
21.
Fiorella DJ, Turk AS, Levy EI, Pride GL Jr, Woo HH, Albuquerque FC, et al. U.S. Wingspan Registry: 12-month follow-up results. Stroke. 2011;42:1976–81.CrossRef
22.
Levy EI, Turk AS, Albuquerque FC, Niemann DB, Aagaard-Kienitz B, Pride L, et al. Wingspan in-stent restenosis and thrombosis: incidence, clinical presentation, and management. Neurosurgery. 2007;61:644–51.CrossRef
23.
Levy EI, Siddiqui AH, Crumlish A, Snyder KV, Hauck EF, Fiorella DJ, et al. First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (stent-assisted recanalization in acute ischemic stroke). Stroke. 2009;40:3552–6.CrossRef
24.
Delgado Acosta F, Jiménez Gómez E, Bravo Rey I, Bravo Rodríguez FA, Ochoa Sepúlveda JJ, Oteros Fernández R. Intracranial stents in the endovascular treatment of acute ischemic stroke. Radiologia. 2017;59:218–25.CrossRef
25.
Woo HG, Sunwoo L, Jung C, Kim BJ, Han MK, Bae HJ, et al. Feasibility of permanent stenting with solitaire FR as a rescue treatment for the reperfusion of acute intracranial artery occlusion. AJNR Am J Neuroradiol. 2018;39:331-6.CrossRefPubMed
Metadata
Title
Intracranial Stenting after Failure of Thrombectomy with the emboTrap® Device
Authors
Sandra A. Cornelissen
Tommy Andersson
Ake Holmberg
Patrick A. Brouwer
Michael Söderman
Pervinder Bhogal
Leonard L. L. Yeo
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 4/2019
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-018-0697-x

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