Rescue Therapy for Failed Mechanical Thrombectomy in Acute Ischemic Stroke: A Pooled Analysis of the Society of Vascular and Interventional Neurology Registry
Aaron Rodriguez-Calienes MD, Fazeel M. Siddiqui MD, Milagros Galecio-Castillo MD, Mahmoud H. Mohammaden MD, Jaydevsinh N. Dolia MD, Jonathan A. Grossberg MD, Aqueel Pabaney MD, Ameer E. Hassan MD, Wondwossen G. Tekle MD, Hamzah Saei MD, Samantha Miller MD, Shahram Majidi MD, Johana T. Fifi MD, Gabrielle Valestin MD, James E. Siegler MD, Mary Penckofer MD, Linda Zhang MD, Sunil A. Sheth MD, Sergio Salazar-Marioni MD, Ananya Iyyangar MD, Thanh N. Nguyen MD, Mohamad Abdalkader MD, Italo Linfante MD, Guilherme Dabus MD, Brijesh P. Mehta MD, Joy Sessa MD, Mouhammad A. Jumma MD, Rebecca M. Sugg MD, Guillermo Linares MD, Raul G. Nogueira MD, David S. Liebeskind MD, Diogo C. Haussen MD, Santiago Ortega-Gutierrez MD, MSc
{"title":"Rescue Therapy for Failed Mechanical Thrombectomy in Acute Ischemic Stroke: A Pooled Analysis of the Society of Vascular and Interventional Neurology Registry","authors":"Aaron Rodriguez-Calienes MD, Fazeel M. Siddiqui MD, Milagros Galecio-Castillo MD, Mahmoud H. Mohammaden MD, Jaydevsinh N. Dolia MD, Jonathan A. Grossberg MD, Aqueel Pabaney MD, Ameer E. Hassan MD, Wondwossen G. Tekle MD, Hamzah Saei MD, Samantha Miller MD, Shahram Majidi MD, Johana T. Fifi MD, Gabrielle Valestin MD, James E. Siegler MD, Mary Penckofer MD, Linda Zhang MD, Sunil A. Sheth MD, Sergio Salazar-Marioni MD, Ananya Iyyangar MD, Thanh N. Nguyen MD, Mohamad Abdalkader MD, Italo Linfante MD, Guilherme Dabus MD, Brijesh P. Mehta MD, Joy Sessa MD, Mouhammad A. Jumma MD, Rebecca M. Sugg MD, Guillermo Linares MD, Raul G. Nogueira MD, David S. Liebeskind MD, Diogo C. Haussen MD, Santiago Ortega-Gutierrez MD, MSc","doi":"10.1002/ana.26967","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>We aimed to evaluate the association between rescue therapy (RT) and functional outcomes compared to medical management (MM) in patients presenting after failed mechanical thrombectomy (MT).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This cross-sectional study utilized prospectively collected and maintained data from the Society of Vascular and Interventional Neurology Registry, spanning from 2011 to 2021. The cohort comprised patients with large vessel occlusions (LVOs) with failed MT. The primary outcome was the shift in the degree of disability, as gauged by the modified Rankin Scale (mRS) at 90 days. Additional outcomes included functional independence (90-day mRS score of 0–2), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of a total of 7,018 patients, 958 presented failed MT and were included in the analysis. The RT group comprised 407 (42.4%) patients, and the MM group consisted of 551 (57.5%) patients. After adjusting for confounders, the RT group showed a favorable shift in the overall 90-day mRS distribution (adjusted common odds ratio = 1.79, 95% confidence interval [CI] = 1.32–2.45, <i>p</i> < 0.001) and higher rates of functional independence (RT: 28.8% vs MM: 15.7%, adjusted odds ratio [aOR] = 1.93, 95% CI = 1.21–3.07, <i>p</i> = 0.005) compared to the MM group. RT also showed lower rates of sICH (RT: 3.8% vs MM: 9.1%, aOR = 0.52, 95% CI = 0.28–0.97, <i>p</i> = 0.039) and 90-day mortality (RT: 33.4% vs MM: 45.5%, aOR = 0.61, 95% CI = 0.42–0.89, <i>p</i> = 0.009).</p>\n </section>\n \n <section>\n \n <h3> Interpretation</h3>\n \n <p>Our findings advocate for the utilization of RT as a potential treatment strategy for cases of LVO resistant to first-line MT techniques. Prospective studies are warranted to validate these observations and optimize the endovascular approach for failed MT patients. ANN NEUROL 2024;96:343–355</p>\n </section>\n </div>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":null,"pages":null},"PeriodicalIF":8.1000,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ana.26967","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Neurology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ana.26967","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
We aimed to evaluate the association between rescue therapy (RT) and functional outcomes compared to medical management (MM) in patients presenting after failed mechanical thrombectomy (MT).
Methods
This cross-sectional study utilized prospectively collected and maintained data from the Society of Vascular and Interventional Neurology Registry, spanning from 2011 to 2021. The cohort comprised patients with large vessel occlusions (LVOs) with failed MT. The primary outcome was the shift in the degree of disability, as gauged by the modified Rankin Scale (mRS) at 90 days. Additional outcomes included functional independence (90-day mRS score of 0–2), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.
Results
Of a total of 7,018 patients, 958 presented failed MT and were included in the analysis. The RT group comprised 407 (42.4%) patients, and the MM group consisted of 551 (57.5%) patients. After adjusting for confounders, the RT group showed a favorable shift in the overall 90-day mRS distribution (adjusted common odds ratio = 1.79, 95% confidence interval [CI] = 1.32–2.45, p < 0.001) and higher rates of functional independence (RT: 28.8% vs MM: 15.7%, adjusted odds ratio [aOR] = 1.93, 95% CI = 1.21–3.07, p = 0.005) compared to the MM group. RT also showed lower rates of sICH (RT: 3.8% vs MM: 9.1%, aOR = 0.52, 95% CI = 0.28–0.97, p = 0.039) and 90-day mortality (RT: 33.4% vs MM: 45.5%, aOR = 0.61, 95% CI = 0.42–0.89, p = 0.009).
Interpretation
Our findings advocate for the utilization of RT as a potential treatment strategy for cases of LVO resistant to first-line MT techniques. Prospective studies are warranted to validate these observations and optimize the endovascular approach for failed MT patients. ANN NEUROL 2024;96:343–355
期刊介绍:
Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.