Rescue intracranial stenting in the endovascular therapy of acute ischaemic stroke

Maria Boutchakova-Meyer, Panagiotis Papanagiotou, Maria Alexandrou, Lukas Meyer, Andreas Kastrup, Christian Roth


Purpose: The present study aimed to evaluate the clinical and angiographic outcome of permanent intracranial stenting as rescue therapy for acute ischaemic stroke (AIS) after failed mechanical thrombectomy (MT). MT has become the standard therapy in AIS in patients with large vessel occlusion. However, failed MT has been reported due to an underlying intracranial atherosclerotic stenosis, residual adherent thrombi or dissection of the target vessel. In such cases, permanent stenting may be required to obtain sufficient recanalisation.

Material and Methods: We retrospectively reviewed collected records of patients treated with intracranial stents for AIS after failed MT in our department between 2013 and 2017. Clinical, angiographic and neuroimaging data were analysed. Neurological status was evaluated with the National Institutes of Health Stroke Scale (NIHSS) score on admission and with the modified Rankin Scale (mRS) score on discharge and after 3 months. The endpoints of this study were recanalisation, clinical outcome at 3 months, symptomatic intracranial haemorrhage (sICH) and mortality at 90 days.    

Results:  Forty patients underwent permanent intracranial stenting after failed MT for AIS. Seventeen stents were self-expanding and 23 drug-eluting, balloon-mounted stents. Twenty occlusions (50%) were located in the anterior circulation, whereas the remaining 20 were in the posterior circulation.  Intravenous recombinant tissue plasminogen activator (rtPA) was administered to 50% of the patients prior to interventional therapy. Successful reperfusion (modified Thrombolysis In Cerebral Infarction 2b-3) was achieved in 37 patients (93%).  A favourable clinical outcome with mRS≤2 after 90 days was observed in 17 patients (42.5%). The overall mortality was 20% at 90 days. sICH occurred in one patient (2.5%).  Post-procedural transcranial sonography revealed acute stent occlusions in 2/35 of patients (5.7%).

Conclusions:  Our study suggests that acute permanent intracranial stenting after failed MT represents a feasible and effective treatment option and has a low risk of symptomatic haemorrhage.


Stroke; Thrombectomy; Intracranial stent; Acute stroke treatment

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Papanagiotou P, White CJ. Endovascular reperfusion strategies for acute stroke. Jacc Cardiovasc Interventions 2016; 9(4): 307-317.

Saver JL, Goyal M, Bonafé A, et al. SolitaireTM with the intention for thrombectomy as primary endovascular treatment for acute ischaemic stroke (SWIFT PRIME) trial: protocol for a randomized, controlled, multicenter study comparing the Solitaire revascularization device with IV tPA with IV tPA alone in acute ischaemic stroke. Int J Stroke 2015; 10(3): 439-448.

Molina CA, Chamorro A, Rovira A, et al. REVASCAT: a randomized trial of revascularization with SOLITAIRE FR device vs. best medical therapy in the treatment of acute stroke due to anterior circulation large vessel occlusion presenting within eight-hours of symptom onset. Int J Stroke 2015; 10(4): 619-626.

Demchuk AM, Goyal M, Menon BK, et al. Endovascular treatment for small core and anterior circulation proximal occlusion with emphasis on minimizing ct to recanalization times (ESCAPE) trial: methodology. Int J Stroke 2015; 10(3): 429-438.

Berkhemer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischaemic stroke. New Engl J Medicine 2015; 372(1): 11-20.

Roth C, Reith W, Walter S, et al. Mechanical recanalization with flow restoration in acute ischaemic stroke: The ReFlow (Mechanical recanalization with flow restoration in acute ischaemic stroke) Study. Jacc Cardiovasc Interventions 2013; 6(4): 386-391.

Meyer L, Politi M, Alexandrou M, et al. Primary aspiration technique in endovascular stroke treatment. Hell J Radiol 2017; 2(2): 20-27.

Singer OC, Berkefeld J, Nolte CH, et al. Mechanical recanalization in basilar artery occlusion: the ENDOSTROKE study. Ann Neurol 2015; 77(3): 415-424.

Mourand I, Machi P, Milhaud D, et al. Mechanical thrombectomy with the Solitaire device in acute basilar artery occlusion. J Neurointerv Surg 2014; 6(3): 200-204.

Kumar G, Shahripour RB, Alexandrov AV. Recanalization of acute basilar artery occlusion improves outcomes: a meta-analysis. J Neurointerv Surg 2015; 7(12): 868-874.

Gao F, Lo WT, Sun X, et al. Combined use of mechanical thrombectomy with angioplasty and stenting for acute basilar occlusions with underlying severe intracranial vertebrobasilar stenosis: preliminary experience from a single Chinese center. Am J Neuroradiol 2015; 36(10): 1947-1952.

Behme D, Weber W, Mpotsaris A. Acute basilar artery occlusion with underlying high-grade basilar artery stenosis: Multimodal endovascular therapy in a series of seven patients. Clin Neuroradiol 2015; 25(3): 267-274.

Fields JD, Lutsep HL, Rymer MR, et al. Endovascular mechanical thrombectomy for the treatment of acute ischaemic stroke due to arterial dissection. Interv Neuroradiol 2012; 18(1): 74-79.

Levy EI, Siddiqui AH, Crumlish A, et al. First Food and Drug Administration-approved prospective trial of primary intracranial stenting for acute stroke: SARIS (stent-assisted recanalization in acute ischaemic stroke). Stroke 2009; 40(11): 3552-3556.

Zaidat OO, Wolfe T, Hussain SI, et al. Interventional acute ischaemic stroke therapy with intracranial self-expanding stent. Stroke 2008; 39(8): 2392-2395.

Yeo LLL, Bhogal P, Gopinathan A, et al. Why does mechanical thrombectomy in large vessel occlusion sometimes fail? : A review of the literature. Clin Neuroradiol 2019; 372(11): 2296-2314.

Kim BM. Causes and solutions of endovascular treatment failure. J Stroke 2017; 19(2): 131-142.

Wareham J, Flood R, Phan K, et al. A systematic review and meta-analysis of observational evidence for the use of bailout self-expandable stents following failed anterior circulation stroke thrombectomy. J Neurointerv Surg 2019; 11(7): 675-682.

Goyal M, Menon BK, Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387(10029): 1723-1731.

Maingard J, Phan K, Lamanna A, et al. Rescue intracranial stenting following failed mechanical thrombectomy for acute ischaemic stroke: a systematic review and meta-analysis. World Neurosurg 2019; 132: e235-e245.

Zhou X, Wu X, Sun H, et al. Efficacy and safety of eptifibatide versus tirofiban in acute coronary syndrome patients: A systematic review and meta-analysis. J Evid Based Med 2017; 10(2): 136-144.

Zinkstok SM, Roos YB, ARTIS investigators. Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial. Lancet 2012; 380(9843): 731-737.

Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the early management of patients with acute ischaemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49(3): e46-e110.

Warner JJ, Harrington RA, Sacco RL, et al. Guidelines for the early management of patients with acute ischaemic stroke: 2019 Update to the 2018 Guidelines for the early management of acute ischaemic stroke. Stroke 2019; 50: 3331-3332.

Kang DH, Yoon W, Kim SK, et al. Endovascular treatment for emergent large vessel occlusion due to severe intracranial atherosclerotic stenosis. J Neurosurg 2018; 130(6): 1-8.

Yilmaz U, Körner H, Mühl-Benninghaus R, et al. Acute occlusions of dual-layer carotid stents after endovascular emergency treatment of tandem lesions. Stroke 2017; 48(8): 2171-2175.

Chang Y, Kim BM, Bang OY, et al. Rescue stenting for failed mechanical thrombectomy in acute ischaemic stroke: A multicenter experience. Stroke 2018; 49(4): 958-964.

Généreux P, Stone GW, Harrington RA, et al. Impact of intraprocedural stent thrombosis during percutaneous coronary intervention insights from the CHAMPION PHOENIX Trial (Clinical trial comparing cangrelor to clopidogrel standard of care therapy in subjects who require percutaneous coronary intervention). J Am Coll Cardiol 2014; 63(7): 619-629.

Thel MC, Califf RM, Tardiff BE, et al. Timing of and risk factors for myocardial ischaemic events after percutaeous coronary intervention (IMPACT-II). Am J Cardiol 2000; 85(4): 427-434.

Stracke CP, Fiehler J, Meyer L, et al. Emergency intracranial stenting in acute stroke: Predictors for poor outcome and for complications. J Am Heart Assoc 2020; 9(5): e012795.

Forbrig R, Lockau H, Flottmann F, et al. Intracranial rescue stent angioplasty after stent-retriever thrombectomy: Multicenter experience. Clin Neuroradiol 2019; 29(3): 445-457.

Kim GE, Yoon W, Kim SK, et al. Incidence and clinical significance of acute reocclusion after emergent angioplasty or stenting for underlying intracranial stenosis in patients with acute stroke. Am J Neuroradiol 2016; 37(9): 1690-1695.

Abou-Chebl A, Bashir Q, Yadav JS. Drug-eluting stents for the treatment of intracranial atherosclerosis. Stroke 2005; 36(12): e165-168.

Park S, Lee DG, Chung WJ, et al. Long-term outcomes of drug-eluting stents in symptomatic intracranial stenosis. Neurointervention 2013; 8(1): 9-14.

Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 2007; 370(9591): 937-948.

Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. New Engl J Med 2004; 350(3): 221-231.

Gross BA, Desai SM, Walker G, et al. Balloon-mounted stents for acute intracranial large vessel occlusion secondary to presumed atherosclerotic disease: evolution in an era of supple intermediate catheters. J Neurointerv Surg 2019; 11(10): 975-978.



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