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

Authors
  • Dobrocky, Tomas1
  • Kaesmacher, Johannes1, 2, 3
  • Bellwald, Sebastian1, 2
  • Piechowiak, Eike1
  • Mosimann, Pascal J.1
  • Zibold, Felix1
  • Jung, Simon2
  • Arnold, Marcel2
  • Fischer, Urs2
  • Gralla, Jan1
  • Mordasini, Pasquale1
  • 1 University of Bern, Inselspital, University Institute of Diagnostic and Interventional Neuroradiology, Freiburgstrasse 8, Bern, 3010, Switzerland , Bern (Switzerland)
  • 2 University of Bern, Inselspital, Department of Neurology, Freiburgstrasse 8, Bern, 3010, Switzerland , Bern (Switzerland)
  • 3 University of Bern, Inselspital, Department of Diagnostic, Interventional and Paediatric Radiology, Freiburgstrasse 8, Bern, 3010, Switzerland , Bern (Switzerland)
Type
Published Article
Journal
CardioVascular and Interventional Radiology
Publisher
Springer-Verlag
Publication Date
Mar 11, 2019
Volume
42
Issue
6
Pages
863–872
Identifiers
DOI: 10.1007/s00270-019-02187-9
Source
Springer Nature
Keywords
License
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Abstract

Background and PurposeData 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 MethodsA 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.ResultsThere 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).ConclusionIn 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 EvidenceLevel 3, non-randomized controlled study.

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