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Rescue stenting versus medical care alone in refractory large vessel occlusions: a systematic review and meta-analysis

  • Kévin PrematEmail author
  • Agnes Dechartres
  • Stéphanie Lenck
  • Eimad Shotar
  • Raphaël Le Bouc
  • Vincent Degos
  • Nader Sourour
  • Sonia Alamowitch
  • Yves Samson
  • Frédéric Clarençon
Interventional Neuroradiology

Abstract

Purpose

Mechanical thrombectomy (MT) failure is associated with very poor prognosis. Permanent intracranial stenting (PIS) may be useful in such refractory occlusions. However, this strategy requires an aggressive antithrombotic regimen that may be harmful in extended strokes. The aim of this study was to compare clinical outcomes between patients with refractory acute large vessel occlusions (LVOs) treated by PIS versus patients for whom the procedure was stopped without recanalization.

Methods

We conducted a systematic review by searching for articles in PubMed, the Cochrane Library, and ClinicalTrials.gov from January 2015 to September 2019. Two reviewers independently selected studies comparing PIS after failed MT in addition to usual care versus usual care only. A comparative meta-analysis was performed using random-effects models to estimate odds ratios of favorable clinical outcome at 90 days, defined as a modified Rankin scale 0–2, mortality and symptomatic intracranial hemorrhage (SICH).

Results

Four comparative studies were included for a total of 352 patients: 149 in the PIS group versus 203 in the control group. PIS was associated with significantly higher rates of 90-day favorable clinical outcome (odds ratio [OR], 2.87 [95% confidence interval (95% CI), 1.77–4.66]; p < 0.001; I2, 0%) and lower mortality (OR, 0.39 [0.16–0.93]; p = 0.03; I2, 43%), whereas SICH rates did not significantly differ (OR, 0.68 [0.37–1.27]; p = 0.23; I2, 0%).

Conclusion

From observational study results, attempting PIS after failed MT seems to improve clinical outcomes without increasing the risk of intracranial bleeding. Randomized trials are needed to confirm these results.

Keywords

Stroke Thrombectomy Endovascular recanalization Reperfusion 

Notes

Funding Information

None

Compliance with ethical standards

Conflict of Interest

NS reports a conflict of interest with Medtronic, Balt Extrusion, Microvention (consultant) and Stock/Stock Options: Medina. FC reports a conflict of interest with Medtronic, Guerbet, Balt Extrusion (payment for readings), and Codman Neurovascular (core lab).

Ethical approval

For this type of study, formal consent is not required.

Informed consent

Not required.

Supplementary material

234_2020_2360_MOESM1_ESM.docx (139 kb)
ESM 1 (DOCX 139 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  • Kévin Premat
    • 1
    Email author
  • Agnes Dechartres
    • 2
  • Stéphanie Lenck
    • 1
  • Eimad Shotar
    • 1
  • Raphaël Le Bouc
    • 3
  • Vincent Degos
    • 4
  • Nader Sourour
    • 1
  • Sonia Alamowitch
    • 5
  • Yves Samson
    • 3
  • Frédéric Clarençon
    • 1
  1. 1.Department of Interventional NeuroradiologySorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix HospitalParisFrance
  2. 2.Departement of BiostatisticsSorbonne University, INSERM, Pierre Louis Institute of Epidemiology and Public Health, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Public Health and Medical InformationParisFrance
  3. 3.Departement of Vascular NeurologySorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix HospitalParisFrance
  4. 4.Department of Anesthesiology and Critical CareSorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix HospitalParisFrance
  5. 5.Departement of Vascular NeurologySorbonne University, AP-HP, Saint Antoine HospitalParisFrance

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