Rescue intracranial stenting for failed posterior circulation thrombectomy: analysis from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study

Mahmoud H Mohammaden; Mohamed A Tarek; Hassan Aboul Nour; Diogo C Haussen; Johanna T Fifi; Stavros Matsoukas; Mudassir Farooqui; Santiago Ortega-Gutierrez; Cynthia B Zevallos; Milagros Galecio-Castillo; Ameer E Hassan; Wondwossen Tekle; Alhamza R Al-Bayati; Mohamed M Salem; Jan Karl Burkhardt; Bryan Pukenas; Gustavo M Cortez; Ricardo A Hanel; Amin Aghaebrahim; Eric Sauvageau; Muhammad Hafeez; Peter Kan; Omar Tanweer; Mouhammad Jumaa; Syed F Zaidi; Marion Oliver; Sunil A Sheth; Michael Nahhas; Sergio Salazar-Marioni; Ahmad Khaldi; Hanzhou Li; Okkes Kuybu; Mohamad Abdalkader; Piers Klein; Sophia Peng; Ali Alaraj; Thanh N Nguyen; Raul G Nogueira

doi:10.1136/jnis-2023-020676

Rescue intracranial stenting for failed posterior circulation thrombectomy: analysis from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study

J Neurointerv Surg. 2023 Sep 12:jnis-2023-020676. doi: 10.1136/jnis-2023-020676. Online ahead of print.

Authors

Mahmoud H Mohammaden^{1

2

3}, Mohamed A Tarek^{2

3}, Hassan Aboul Nour^{2

3

4}, Diogo C Haussen^{2

3}, Johanna T Fifi⁵, Stavros Matsoukas⁵, Mudassir Farooqui⁶, Santiago Ortega-Gutierrez⁷, Cynthia B Zevallos⁸, Milagros Galecio-Castillo⁹, Ameer E Hassan¹⁰, Wondwossen Tekle¹¹, Alhamza R Al-Bayati¹², Mohamed M Salem¹³, Jan Karl Burkhardt¹³, Bryan Pukenas¹⁴, Gustavo M Cortez¹⁵, Ricardo A Hanel¹⁵, Amin Aghaebrahim¹⁵, Eric Sauvageau¹⁵, Muhammad Hafeez¹⁶, Peter Kan¹⁷, Omar Tanweer¹⁸, Mouhammad Jumaa¹⁹, Syed F Zaidi¹⁹, Marion Oliver²⁰, Sunil A Sheth²¹, Michael Nahhas²², Sergio Salazar-Marioni²¹, Ahmad Khaldi²³, Hanzhou Li²⁴, Okkes Kuybu²⁵, Mohamad Abdalkader²⁶, Piers Klein²⁷, Sophia Peng²⁸, Ali Alaraj²⁸, Thanh N Nguyen²⁹, Raul G Nogueira^{30

31}

Affiliations

¹ Neurology, South Valley University Faculty of Medicine, Qena, Egypt.
² Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
³ Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.
⁴ Neurology and Neurosurgery, University of Kentucky, Lexington, Kentucky, USA.
⁵ Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁶ Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
⁷ Neuroloy, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
⁸ Neurology, University of Iowa, Iowa City, Iowa, USA.
⁹ Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹⁰ Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA.
¹¹ Neurology, UTRGV School of Medicine, Harlingen, Texas, USA.
¹² Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA.
¹³ Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁴ Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁵ Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA.
¹⁶ Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
¹⁷ Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA.
¹⁸ Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
¹⁹ Neurology, University of Toledo - Health Science Campus, Toledo, Ohio, USA.
²⁰ Department of Neurology, University of Toledo - Health Science Campus, Toledo, Ohio, USA.
²¹ Neurology, University of Texas McGovern Medical School, Houston, Texas, USA.
²² Department of Neurosurgery, University of Texas McGovern Medical School, Houston, Texas, USA.
²³ Neurosurgery, WellStar Health System, Marietta, Georgia, USA.
²⁴ Department of Neurosciences, WellStar Health System, Marietta, Georgia, USA.
²⁵ Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁶ Radiology, Boston University Medical Center, Boston, Massachusetts, USA.
²⁷ Neurology, Radiology, Boston University School of Medicine, Boston, Massachusetts, USA.
²⁸ Neurosurgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA.
²⁹ Neurology, Boston University Medical Center, Boston, Massachusetts, USA.
³⁰ Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA raul.g.nogueira@icloud.com.
³¹ Department of Neurology, Neurosurgery, UPMC, Pittsburgh, Pennsylvania, USA.

PMID: 37699704
DOI: 10.1136/jnis-2023-020676

Abstract

Backgrounds: Recent trials have shown improved outcomes after mechanical thrombectomy (MT) for vertebrobasilar occlusion (VBO) stroke. However, there is a paucity of data regarding safety and outcomes of rescue intracranial stenting (RS) after failed MT (FRRS+) for posterior circulation stroke. We sought to compare RS to failed reperfusion without RS (FRRS-).

Methods: This is a retrospective analysis of the Stenting and Angioplasty in NeuroThrombectomy (SAINT) study, a multicenter collaboration involving prospectively collected databases. Patients were included if they had posterior circulation stroke and failed MT. The cohort was divided into two groups: FRRS+ and FRRS- (defined as modified Thrombolysis In Cerebral Infarction (mTICI) score 0-2a). The primary outcome was a shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included mRS 0-2 and mRS 0-3 at 90 days. Safety measures included rates of symptomatic intracranial hemorrhage (sICH), procedural complications, and 90-day mortality. Sensitivity and subgroup analyses were performed to identify outcomes in a matched cohort and in those with VBO, respectively.

Results: A total of 152 failed thrombectomies were included in the analysis. FRRS+ (n=84) was associated with increased likelihood of lower disability (acOR 2.24, 95% CI 1.04 to 4.95, P=0.04), higher rates of mRS 0-2 (26.8% vs 12.5%, aOR 4.43, 95% CI 1.22 to 16.05, P=0.02) and mRS 0-3 (35.4% vs 18.8%, aOR 3.13, 95% CI 1.08 to 9.10, P=0.036), and lower mortality (42.7% vs 59.4%, aOR 0.40, 95% CI 0.17 to 0.97, P=0.04) at 90 days compared with FRRS- (n=68). The rates of sICH and procedural complications were comparable between the groups. Sensitivity and subgroup analyses showed similar results.

Conclusion: In patients with posterior circulation stroke who had failed MT, RS resulted in better functional outcomes with comparable safety profile to procedure termination.

Keywords: Stent; Stroke; Thrombectomy.