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Rodrigo-Gisbert M, Hoferica M, García-Tornel A, Requena M, Rubiera M, Lascuevas MDD, Olivé-Gadea M, Diana F, Rizzo F, Muchada M, Carmona T, Rodriguez-Villatoro N, Rodríguez-Luna D, Juega J, Pagola J, Hernández D, Molina CA, Tomasello A, Cognard C, Ribó M. Stent Retriever AssIsted Lysis Technique with Tirofiban: A Potential Bailout Alternative to Angioplasty and Stenting. AJNR Am J Neuroradiol 2024:ajnr.A8374. [PMID: 38849135 DOI: 10.3174/ajnr.a8374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND PURPOSE Angioplasty and stent placement have been described as a bailout technique in individuals with failed thrombectomy. We aimed to investigate Stent retriever AssIsted Lysis (SAIL) with tirofiban before angioplasty and stent placement. MATERIALS AND METHODS Patients from 2 comprehensive stroke centers were reviewed (2020-2023). We included patients with failed thrombectomy and/or underlying intracranial stenosis who received SAIL with tirofiban before the intended angioplasty and stent placement. SAIL consisted of deploying a stent retriever through the occluding lesion to create a bypass channel and infuse 10 mL of tirofiban for 10 minutes either intra-arterially or IV. The stent retriever was re-sheathed before retrieval. The primary end points were successful reperfusion (expanded TICI 2b-3) and symptomatic intracerebral hemorrhage. Additional end points included 90-day mRS 0-2 and mortality. RESULTS After a median of 3 (interquartile range, 2-4) passes, 44 patients received the SAIL bridging protocol with tirofiban, and later they were considered potential candidates for angioplasty and stent placement bailout (43.2%, intra-arterial SAIL). Post-SAIL successful reperfusion was obtained in 79.5%. A notable residual stenosis (>50%) after successful SAIL was observed in 45.7%. No significant differences were detected according to post-SAIL: successful reperfusion (intra-arterial SAIL, 80.0% versus IV-SAIL, 78.9%; P = .932), significant stenosis (33.3% versus 55.0%; P = .203), early symptomatic re-occlusion (0% versus 8.0%; P = .207), or symptomatic intracerebral hemorrhage (5.3% versus 8.0%; P = .721). Rescue angioplasty and stent placement were finally performed in 15 (34.1%) patients (intra-arterial SAIL 21.0% versus IV-SAIL 44%; P = .112). At 90 days, mRS 0-2 (intra-arterial SAIL 50.0% versus IV-SAIL 43.5%; P = .086) and mortality (26.3% versus 12.0%; P = .223) were also similar. CONCLUSIONS In patients with stroke in which angioplasty and stent placement are considered, SAIL with tirofiban, either intra-arterial or IV, seems to safely induce sustained recanalization, offering a potential alternative to definitive angioplasty and stent placement.
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Affiliation(s)
- Marc Rodrigo-Gisbert
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matúš Hoferica
- Department of Diagnostic Neuroradiology (M.H., C.C.), Hôpital Purpan, Centre Hospitalier Universitaire, Toulouse, France
| | - Alvaro García-Tornel
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Requena
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marta Rubiera
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta De Dios Lascuevas
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marta Olivé-Gadea
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesco Diana
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Federica Rizzo
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marian Muchada
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomás Carmona
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Noelia Rodriguez-Villatoro
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Rodríguez-Luna
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesus Juega
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Pagola
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Hernández
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos A Molina
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Tomasello
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Christophe Cognard
- Department of Diagnostic Neuroradiology (M.H., C.C.), Hôpital Purpan, Centre Hospitalier Universitaire, Toulouse, France
| | - Marc Ribó
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
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Jia B, Zhang L, Pan Y, Tong X, Zhang X, Mo D, Ma N, Luo G, Song L, Li X, Wang B, Nguyen TN, Gao F, Miao Z. Rescue angioplasty and/or stenting after mechanical thrombectomy: who can benefit? J Neurointerv Surg 2023:jnis-2023-020824. [PMID: 38050150 DOI: 10.1136/jnis-2023-020824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/25/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Angioplasty and/or stenting is a rescue therapy for mechanical thrombectomy (MT) in acute intracranial large vessel occlusion. This study was undertaken to determine whether rescue angioplasty and/or stenting improves the outcome after MT and to investigate whether outcomes differ by subgroup of rescue indication. METHODS We performed propensity score matching (PSM) with data from a prospective multicenter registry of patients with acute large vessel occlusion receiving endovascular treatment. Patients were divided into the MT alone group and the MT with rescue therapy group. The primary outcome was functional independence (modified Rankin Scale score of 0-2) at 90 days. PSM was also performed in the failed MT (modified Thrombolysis In Cerebral Infarction (mTICI) 0-2a) and the residual severe stenosis (mTICI 2b-3) subgroups, respectively. RESULTS 326 patients of mean±SD age 62.7±12.0 years (90 women, 27.6%) were matched from 1274 patients. In the matched cohort, functional independence at 90 days was higher in the rescue therapy group than in the MT alone group (44.2% vs 29.5%; OR 1.90, 95% CI 1.18 to 3.06, P=0.008). In the failed MT subgroup with 66 matched pairs, more patients had functional independence in the rescue therapy group than in the MT alone group (39.0% vs 17.0%; OR 3.12, 95% CI 1.29 to 7.59, P=0.01). In the residual stenosis subgroup with 63 matched pairs, functional independence rates were similar in the rescue therapy and the MT alone groups (51.6% vs 55.7%; OR 0.85, 95% CI 0.42 to 1.72, P=0.65). CONCLUSION Rescue angioplasty and/or stenting could improve the clinical outcome in patients with acute large vessel occlusion with failed MT, while no benefit was seen in those with residual severe stenosis but substantial reperfusion.
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Affiliation(s)
- BaiXue Jia
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Longhui Zhang
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuelei Zhang
- Stroke Center, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gang Luo
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ligang Song
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoqing Li
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Wang
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Thanh N Nguyen
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Feng Gao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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