Sami Al Kasab, Eyad Almallouhi, Mouhammad A Jumaa, Violiza Inoa, Francesco Capasso, Michael I Nahhas, Robert M Starke, Isabel R Fragata, Matthew T Bender, Krisztina Moldovan, Shadi Yaghi, Ilko L Maier, Jonathan A Grossberg, Pascal M Jabbour, Marios-Nikos Psychogios, Edgar A Samaniego, Jan-Karl Burkhardt, Brian T Jankowitz, Mohamad Abdalkader, Ameer E Hassan, David J Altschul, Justin Mascitelli, Robert W Regenhardt, Stacey Q Wolfe, Mohamad Ezzeldin, Kaustubh Limaye, Ramesh Grandhi, Hossam Al-Jehani, Muhammad Niazi, Nitin Goyal, Stavropoula I Tjoumakaris, Ali M Alawieh, Ahmed Abdelsalam, Luis Guada, Nikolaos Ntoulias, Reem El-Ghawanmeh, Vivek Batra, Ashley Choi, Youssef M Zohdy, Sarah Nguyen, Muhammed Amir Essibayi, Kareem El Naamani, Andrew B Koo, Mohammed A Almekhlafi, Eytan Raz, Samantha Miller, Adam Mierzwa, Syed F Zaidi, Andres S Gudino, Ali Alsarah, Hussain Azeem, Thomas K Mattingly, Derrek Schartz, Ashley M Nelson, Carolina Pinheiro, Alejandro M Spiotta, Kimberly P Kicielinski, Jonathan Lena, Orgest Lajthia, Zachary Hubbard, Osama O Zaidat, Colin P Derdeyn, Piers Klein, Thanh N Nguyen, Adam de Havenon
{"title":"辅助紧急支架植入术与单纯机械血栓切除术的疗效：RESCUE-ICAS 登记。","authors":"Sami Al Kasab, Eyad Almallouhi, Mouhammad A Jumaa, Violiza Inoa, Francesco Capasso, Michael I Nahhas, Robert M Starke, Isabel R Fragata, Matthew T Bender, Krisztina Moldovan, Shadi Yaghi, Ilko L Maier, Jonathan A Grossberg, Pascal M Jabbour, Marios-Nikos Psychogios, Edgar A Samaniego, Jan-Karl Burkhardt, Brian T Jankowitz, Mohamad Abdalkader, Ameer E Hassan, David J Altschul, Justin Mascitelli, Robert W Regenhardt, Stacey Q Wolfe, Mohamad Ezzeldin, Kaustubh Limaye, Ramesh Grandhi, Hossam Al-Jehani, Muhammad Niazi, Nitin Goyal, Stavropoula I Tjoumakaris, Ali M Alawieh, Ahmed Abdelsalam, Luis Guada, Nikolaos Ntoulias, Reem El-Ghawanmeh, Vivek Batra, Ashley Choi, Youssef M Zohdy, Sarah Nguyen, Muhammed Amir Essibayi, Kareem El Naamani, Andrew B Koo, Mohammed A Almekhlafi, Eytan Raz, Samantha Miller, Adam Mierzwa, Syed F Zaidi, Andres S Gudino, Ali Alsarah, Hussain Azeem, Thomas K Mattingly, Derrek Schartz, Ashley M Nelson, Carolina Pinheiro, Alejandro M Spiotta, Kimberly P Kicielinski, Jonathan Lena, Orgest Lajthia, Zachary Hubbard, Osama O Zaidat, Colin P Derdeyn, Piers Klein, Thanh N Nguyen, Adam de Havenon","doi":"10.1161/STROKEAHA.124.049038","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Underlying intracranial stenosis is the most common cause of failed mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion. Adjunct emergent stenting is sometimes performed to improve or maintain reperfusion, despite limited data regarding its safety or efficacy.</p><p><strong>Methods: </strong>We conducted a prospective multicenter observational international cohort study. Patients were enrolled between January 2022 and December 2023 at 25 thrombectomy capable centers in North America, Europe, and Asia. Consecutive patients treated with mechanical thrombectomy were included if they were identified as having underlying intracranial stenosis, defined as 50-99% residual stenosis of the target vessel or intra-procedural re-occlusion. The primary outcome was functional independence, defined as modified Rankin Scale of 0-2 at 90 days. After applying inverse probability of treatment weighting (IPTW) based on propensity scores, we compared outcomes among patients who underwent adjunct emergent intracranial stenting (stenting) versus those who received mechanical thrombectomy alone.</p><p><strong>Results: </strong>A total of 417 patients were included; 218 patients treated with mechanical thrombectomy alone (168 anterior circulation) and 199 with mechanical thrombectomy plus stenting (144 anterior circulation). Patients in the stenting group were less likely to be non-Hispanic White (51.8% vs 62.4%, p=0.03), and less likely to have diabetes (33.2% vs 43.1%, p=0.037) or hyperlipidemia (43.2% vs 56%, p= 0.009). In addition, there was a lower rate of IV thrombolysis use in the stenting group (18.6% vs 27.5%, p=0.03). There was a higher rate of successful reperfusion (modified Treatment In Cerebral Infarction score ≥ 2B) in the stenting versus mechanical thrombectomy alone group (90.9% vs 77.9%, p<0.001) and a higher rate of a 24-hour infarct volume of <30 mL (n=260, 67.9% vs 50.3%, p=0.005). The overall complication rate was higher in the stenting group (12.6% vs 5%, p=0.006), but there was not a significant difference in the rate of symptomatic hemorrhage (9% vs 5.5%, p=0.162). Functional independence at 90 days was significantly higher in the stenting group (42.2% vs. 28.4%, adjusted odds ratio 2.67; 95% CI, 1.66-4.32).</p><p><strong>Conclusions: </strong>In patients with underlying stenosis who achieved reperfusion with mechanical thrombectomy, adjunct emergent stenting was associated with better functional outcome without a significantly increased risk of symptomatic hemorrhage.</p><p><strong>Registration: </strong>https://clinicaltrials.gov/study/NCT05403593.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8000,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Outcomes of Adjunct Emergent Stenting Versus Mechanical Thrombectomy Alone: The RESCUE-ICAS Registry.\",\"authors\":\"Sami Al Kasab, Eyad Almallouhi, Mouhammad A Jumaa, Violiza Inoa, Francesco Capasso, Michael I Nahhas, Robert M Starke, Isabel R Fragata, Matthew T Bender, Krisztina Moldovan, Shadi Yaghi, Ilko L Maier, Jonathan A Grossberg, Pascal M Jabbour, Marios-Nikos Psychogios, Edgar A Samaniego, Jan-Karl Burkhardt, Brian T Jankowitz, Mohamad Abdalkader, Ameer E Hassan, David J Altschul, Justin Mascitelli, Robert W Regenhardt, Stacey Q Wolfe, Mohamad Ezzeldin, Kaustubh Limaye, Ramesh Grandhi, Hossam Al-Jehani, Muhammad Niazi, Nitin Goyal, Stavropoula I Tjoumakaris, Ali M Alawieh, Ahmed Abdelsalam, Luis Guada, Nikolaos Ntoulias, Reem El-Ghawanmeh, Vivek Batra, Ashley Choi, Youssef M Zohdy, Sarah Nguyen, Muhammed Amir Essibayi, Kareem El Naamani, Andrew B Koo, Mohammed A Almekhlafi, Eytan Raz, Samantha Miller, Adam Mierzwa, Syed F Zaidi, Andres S Gudino, Ali Alsarah, Hussain Azeem, Thomas K Mattingly, Derrek Schartz, Ashley M Nelson, Carolina Pinheiro, Alejandro M Spiotta, Kimberly P Kicielinski, Jonathan Lena, Orgest Lajthia, Zachary Hubbard, Osama O Zaidat, Colin P Derdeyn, Piers Klein, Thanh N Nguyen, Adam de Havenon\",\"doi\":\"10.1161/STROKEAHA.124.049038\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Underlying intracranial stenosis is the most common cause of failed mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion. Adjunct emergent stenting is sometimes performed to improve or maintain reperfusion, despite limited data regarding its safety or efficacy.</p><p><strong>Methods: </strong>We conducted a prospective multicenter observational international cohort study. Patients were enrolled between January 2022 and December 2023 at 25 thrombectomy capable centers in North America, Europe, and Asia. Consecutive patients treated with mechanical thrombectomy were included if they were identified as having underlying intracranial stenosis, defined as 50-99% residual stenosis of the target vessel or intra-procedural re-occlusion. The primary outcome was functional independence, defined as modified Rankin Scale of 0-2 at 90 days. After applying inverse probability of treatment weighting (IPTW) based on propensity scores, we compared outcomes among patients who underwent adjunct emergent intracranial stenting (stenting) versus those who received mechanical thrombectomy alone.</p><p><strong>Results: </strong>A total of 417 patients were included; 218 patients treated with mechanical thrombectomy alone (168 anterior circulation) and 199 with mechanical thrombectomy plus stenting (144 anterior circulation). Patients in the stenting group were less likely to be non-Hispanic White (51.8% vs 62.4%, p=0.03), and less likely to have diabetes (33.2% vs 43.1%, p=0.037) or hyperlipidemia (43.2% vs 56%, p= 0.009). In addition, there was a lower rate of IV thrombolysis use in the stenting group (18.6% vs 27.5%, p=0.03). There was a higher rate of successful reperfusion (modified Treatment In Cerebral Infarction score ≥ 2B) in the stenting versus mechanical thrombectomy alone group (90.9% vs 77.9%, p<0.001) and a higher rate of a 24-hour infarct volume of <30 mL (n=260, 67.9% vs 50.3%, p=0.005). The overall complication rate was higher in the stenting group (12.6% vs 5%, p=0.006), but there was not a significant difference in the rate of symptomatic hemorrhage (9% vs 5.5%, p=0.162). Functional independence at 90 days was significantly higher in the stenting group (42.2% vs. 28.4%, adjusted odds ratio 2.67; 95% CI, 1.66-4.32).</p><p><strong>Conclusions: </strong>In patients with underlying stenosis who achieved reperfusion with mechanical thrombectomy, adjunct emergent stenting was associated with better functional outcome without a significantly increased risk of symptomatic hemorrhage.</p><p><strong>Registration: </strong>https://clinicaltrials.gov/study/NCT05403593.</p>\",\"PeriodicalId\":21989,\"journal\":{\"name\":\"Stroke\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.8000,\"publicationDate\":\"2024-11-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Stroke\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/STROKEAHA.124.049038\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Stroke","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/STROKEAHA.124.049038","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Outcomes of Adjunct Emergent Stenting Versus Mechanical Thrombectomy Alone: The RESCUE-ICAS Registry.
Background: Underlying intracranial stenosis is the most common cause of failed mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion. Adjunct emergent stenting is sometimes performed to improve or maintain reperfusion, despite limited data regarding its safety or efficacy.
Methods: We conducted a prospective multicenter observational international cohort study. Patients were enrolled between January 2022 and December 2023 at 25 thrombectomy capable centers in North America, Europe, and Asia. Consecutive patients treated with mechanical thrombectomy were included if they were identified as having underlying intracranial stenosis, defined as 50-99% residual stenosis of the target vessel or intra-procedural re-occlusion. The primary outcome was functional independence, defined as modified Rankin Scale of 0-2 at 90 days. After applying inverse probability of treatment weighting (IPTW) based on propensity scores, we compared outcomes among patients who underwent adjunct emergent intracranial stenting (stenting) versus those who received mechanical thrombectomy alone.
Results: A total of 417 patients were included; 218 patients treated with mechanical thrombectomy alone (168 anterior circulation) and 199 with mechanical thrombectomy plus stenting (144 anterior circulation). Patients in the stenting group were less likely to be non-Hispanic White (51.8% vs 62.4%, p=0.03), and less likely to have diabetes (33.2% vs 43.1%, p=0.037) or hyperlipidemia (43.2% vs 56%, p= 0.009). In addition, there was a lower rate of IV thrombolysis use in the stenting group (18.6% vs 27.5%, p=0.03). There was a higher rate of successful reperfusion (modified Treatment In Cerebral Infarction score ≥ 2B) in the stenting versus mechanical thrombectomy alone group (90.9% vs 77.9%, p<0.001) and a higher rate of a 24-hour infarct volume of <30 mL (n=260, 67.9% vs 50.3%, p=0.005). The overall complication rate was higher in the stenting group (12.6% vs 5%, p=0.006), but there was not a significant difference in the rate of symptomatic hemorrhage (9% vs 5.5%, p=0.162). Functional independence at 90 days was significantly higher in the stenting group (42.2% vs. 28.4%, adjusted odds ratio 2.67; 95% CI, 1.66-4.32).
Conclusions: In patients with underlying stenosis who achieved reperfusion with mechanical thrombectomy, adjunct emergent stenting was associated with better functional outcome without a significantly increased risk of symptomatic hemorrhage.
期刊介绍：
Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery.
The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists.
Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.
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