Rescue Stent Placement for Acute Ischemic Stroke with Large Vessel Occlusion Refractory to Mechanical Thrombectomy: A Multiethnic Middle Eastern/African/Asian Cohort.

Overview

abstract

INTRODUCTION: Rescue stent placement for refractory large vessel occlusion is an emerging technique, especially in East Asia. The aim was to investigate the safety and efficacy of rescue stent placement in acute stroke patients with failed mechanical thrombectomy. METHODS: A retrospective review of a multiethnic stroke database. Post-stenting, an aggressive antiplatelet protocol was followed with glycoprotein IIb/IIIa infusion. Primary outcomes were incidence of intracerebral hemorrhage (ICH), recanalization score, and favorable prognosis (modified Rankin Score ≤2) at 90. Comparison was made between patients from the Middle East and North Africa (MENA) region and others. RESULTS: 55 patients were included, 87.3% male. The mean age was 51.3+11.8 years. 32 (58.3%) patients were from South Asia, 12 (21.8%) MENA, 9 (16.4%) from Southeast Asia, and 2 (3.6%) from elsewhere. Successful recanalization (modified Thrombolysis in cerebral infarction = 2b-3) was achieved in 43 (78.2%) and symptomatic ICH occurred in 2 (3.6%). A favorable outcome at 90 days was seen in 26/55 (47.3%). Apart from significantly older age, mean 62.8+13 years (median 69) vs. 48.1+9.3 (median 49) and coronary artery disease burden 4 (33.3%) vs.1 (2.3%) (p<0.05). MENA patients had similar risk factors, stroke severity, recanalization rates, ICH rates, and 90-day outcomes to South and Southeast Asia. CONCLUSION: Rescue stent placement showed good outcomes and a low risk of clinically significant bleeding in a multiethnic cohort of patients from MENA, South and Southeast Asia similar to earlier published literature.