Intracranial Stenting After Failed Thrombectomy in Patients With Moderately Severe Stroke: A Multicenter Cohort Study

Lukas Meyer; Jens Fiehler; Götz Thomalla; Lars Udo Krause; Stephan Lowens; Jan Rothaupt; Byung Moon Kim; Ji Hoe Heo; Leonard Yeo; Tommy Andersson; Christoph Kabbasch; Franziska Dorn; René Chapot; Christian Paul Stracke; Uta Hanning

doi:10.3389/fneur.2020.00097

Intracranial Stenting After Failed Thrombectomy in Patients With Moderately Severe Stroke: A Multicenter Cohort Study

Lukas Meyer, Jens Fiehler, Götz Thomalla, Lars Udo Krause, Stephan Lowens, Jan Rothaupt, Byung Moon Kim, Ji Hoe Heo, Leonard Yeo, Tommy Andersson, Christoph Kabbasch, Franziska Dorn, René Chapot, Christian Paul Stracke, Uta Hanning

Research output: Contribution to journal › Article › peer-review

9 Citations (Scopus)

Abstract

Background and Purpose: Recently, acute intracranial stenting (ICS) has gained more interest as a potential bailout strategy for large vessel occlusions (LVO) that are refractory to thrombectomy. However, there are currently no reports on ICS in patients with moderately severe stroke discussing the question if implementing a permanent stent is feasible and leads to improved recanalization after failed thrombectomy. Methods: We analyzed a large multicenter database of patients receiving ICS for anterior circulation LVO after failed thrombectomy. Inclusion criteria were defined as: Moderately severe stroke (National Institute Health Stroke Scale (NIHSS) ≤9 on admission), anterior circulation LVO, acute ICS after failed stent retriever MT. Primary endpoint was the rate of improved successful recanalization after ICS defined as a modified Thrombolysis In cerebral Infarction (mTICI) score≥2b. Favorable neurological outcome was defined as an early neurological improvement (ENI) of 4 points or reaching 0 with respect to baseline NIHSS. Results: Forty-one patients met the inclusion criteria. A median of 2 retrievals were performed (IQR 1–4) prior decision-making for ICS. ICS led in 90.2% (37/41) of cases to a final mTICI≥2b with significant improvement (p < 0.001) after the last retrieval attempt. The median NIHSS decreased (p = 0.178) from 7 (IQR 3.5–8) on admission to 2.5 (IQR 0–8.25) at discharge. ENI was observed in 47.4% (18/38). sICH occurred in 4.8% (2/41). Conclusion: ICS after failed thrombectomy appears to effectively improve recanalization rates in patients with moderately severe strokes. Thus, ICS should be considered also for patients with baseline NIHSS ≤9 if thrombectomy fails.

Original language	English
Article number	97
Journal	Frontiers in Neurology
Volume	11
DOIs	https://doi.org/10.3389/fneur.2020.00097
Publication status	Published - 2020 Feb 14

Bibliographical note

Funding Information:
Conflict of Interest: JF received research support from German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions-und Förderbank (IFB), Medtronic, Microvention, Philips, Stryker, Consultant for: Acandis, Boehringer Ingelheim, Cerenovus, Covidien, Evasc Neurovascular, MD Clinicals, Medtronic, Medina, Microvention, Penumbra, Route92, Stryker, Transverse Medical. GT received consulting fees from Acandis, grant support and lecture fees from Bayer, lecture fees from Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, and Daiichi Sankyo, and consulting fees and lecture fees from Stryker. LK received speaker honoraria from Boehringer Ingelheim, Medtronic and JR is consultant for Acandis and Phenox. TA is a consultant for Ablynx, Amnis Therapeutics, Medtronic, Cerenovus/J&J, Rapid Medical and Anaconda. LY has received substantial grant funding from the National Medical Research Council (NMRC), Singapore and substantial support from the ministry of health (MOH), Singapore. CK is proctor for Acandis. FD is consultant for Acandis. RC is consultant and/or proctor for BALT, Stryker, Microvention, Rapid Medical, Siemens Medical Systems. CS is consultant and/or proctor for Acandis, Balt, and Rapid Medical.

Publisher Copyright:
© Copyright © 2020 Meyer, Fiehler, Thomalla, Krause, Lowens, Rothaupt, Kim, Heo, Yeo, Andersson, Kabbasch, Dorn, Chapot, Stracke and Hanning.

All Science Journal Classification (ASJC) codes

Neurology
Clinical Neurology

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10.3389/fneur.2020.00097

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Meyer, L., Fiehler, J., Thomalla, G., Krause, L. U., Lowens, S., Rothaupt, J., Kim, B. M., Heo, J. H., Yeo, L., Andersson, T., Kabbasch, C., Dorn, F., Chapot, R., Stracke, C. P., & Hanning, U. (2020). Intracranial Stenting After Failed Thrombectomy in Patients With Moderately Severe Stroke: A Multicenter Cohort Study. Frontiers in Neurology, 11, [97]. https://doi.org/10.3389/fneur.2020.00097

@article{76777e8717d94ab6b0b7118c7e512802,

title = "Intracranial Stenting After Failed Thrombectomy in Patients With Moderately Severe Stroke: A Multicenter Cohort Study",

abstract = "Background and Purpose: Recently, acute intracranial stenting (ICS) has gained more interest as a potential bailout strategy for large vessel occlusions (LVO) that are refractory to thrombectomy. However, there are currently no reports on ICS in patients with moderately severe stroke discussing the question if implementing a permanent stent is feasible and leads to improved recanalization after failed thrombectomy. Methods: We analyzed a large multicenter database of patients receiving ICS for anterior circulation LVO after failed thrombectomy. Inclusion criteria were defined as: Moderately severe stroke (National Institute Health Stroke Scale (NIHSS) ≤9 on admission), anterior circulation LVO, acute ICS after failed stent retriever MT. Primary endpoint was the rate of improved successful recanalization after ICS defined as a modified Thrombolysis In cerebral Infarction (mTICI) score≥2b. Favorable neurological outcome was defined as an early neurological improvement (ENI) of 4 points or reaching 0 with respect to baseline NIHSS. Results: Forty-one patients met the inclusion criteria. A median of 2 retrievals were performed (IQR 1–4) prior decision-making for ICS. ICS led in 90.2% (37/41) of cases to a final mTICI≥2b with significant improvement (p < 0.001) after the last retrieval attempt. The median NIHSS decreased (p = 0.178) from 7 (IQR 3.5–8) on admission to 2.5 (IQR 0–8.25) at discharge. ENI was observed in 47.4% (18/38). sICH occurred in 4.8% (2/41). Conclusion: ICS after failed thrombectomy appears to effectively improve recanalization rates in patients with moderately severe strokes. Thus, ICS should be considered also for patients with baseline NIHSS ≤9 if thrombectomy fails.",

author = "Lukas Meyer and Jens Fiehler and G{\"o}tz Thomalla and Krause, {Lars Udo} and Stephan Lowens and Jan Rothaupt and Kim, {Byung Moon} and Heo, {Ji Hoe} and Leonard Yeo and Tommy Andersson and Christoph Kabbasch and Franziska Dorn and Ren{\'e} Chapot and Stracke, {Christian Paul} and Uta Hanning",

note = "Funding Information: Conflict of Interest: JF received research support from German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions-und F{\"o}rderbank (IFB), Medtronic, Microvention, Philips, Stryker, Consultant for: Acandis, Boehringer Ingelheim, Cerenovus, Covidien, Evasc Neurovascular, MD Clinicals, Medtronic, Medina, Microvention, Penumbra, Route92, Stryker, Transverse Medical. GT received consulting fees from Acandis, grant support and lecture fees from Bayer, lecture fees from Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, and Daiichi Sankyo, and consulting fees and lecture fees from Stryker. LK received speaker honoraria from Boehringer Ingelheim, Medtronic and JR is consultant for Acandis and Phenox. TA is a consultant for Ablynx, Amnis Therapeutics, Medtronic, Cerenovus/J&J, Rapid Medical and Anaconda. LY has received substantial grant funding from the National Medical Research Council (NMRC), Singapore and substantial support from the ministry of health (MOH), Singapore. CK is proctor for Acandis. FD is consultant for Acandis. RC is consultant and/or proctor for BALT, Stryker, Microvention, Rapid Medical, Siemens Medical Systems. CS is consultant and/or proctor for Acandis, Balt, and Rapid Medical. Publisher Copyright: {\textcopyright} Copyright {\textcopyright} 2020 Meyer, Fiehler, Thomalla, Krause, Lowens, Rothaupt, Kim, Heo, Yeo, Andersson, Kabbasch, Dorn, Chapot, Stracke and Hanning.",

year = "2020",

month = feb,

day = "14",

doi = "10.3389/fneur.2020.00097",

language = "English",

volume = "11",

journal = "Frontiers in Neurology",

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Meyer, L, Fiehler, J, Thomalla, G, Krause, LU, Lowens, S, Rothaupt, J, Kim, BM , Heo, JH, Yeo, L, Andersson, T, Kabbasch, C, Dorn, F, Chapot, R, Stracke, CP & Hanning, U 2020, 'Intracranial Stenting After Failed Thrombectomy in Patients With Moderately Severe Stroke: A Multicenter Cohort Study', Frontiers in Neurology, vol. 11, 97. https://doi.org/10.3389/fneur.2020.00097

TY - JOUR

T1 - Intracranial Stenting After Failed Thrombectomy in Patients With Moderately Severe Stroke

T2 - A Multicenter Cohort Study

AU - Meyer, Lukas

AU - Fiehler, Jens

AU - Thomalla, Götz

AU - Krause, Lars Udo

AU - Lowens, Stephan

AU - Rothaupt, Jan

AU - Kim, Byung Moon

AU - Heo, Ji Hoe

AU - Yeo, Leonard

AU - Andersson, Tommy

AU - Kabbasch, Christoph

AU - Dorn, Franziska

AU - Chapot, René

AU - Stracke, Christian Paul

AU - Hanning, Uta

N1 - Funding Information: Conflict of Interest: JF received research support from German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions-und Förderbank (IFB), Medtronic, Microvention, Philips, Stryker, Consultant for: Acandis, Boehringer Ingelheim, Cerenovus, Covidien, Evasc Neurovascular, MD Clinicals, Medtronic, Medina, Microvention, Penumbra, Route92, Stryker, Transverse Medical. GT received consulting fees from Acandis, grant support and lecture fees from Bayer, lecture fees from Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, and Daiichi Sankyo, and consulting fees and lecture fees from Stryker. LK received speaker honoraria from Boehringer Ingelheim, Medtronic and JR is consultant for Acandis and Phenox. TA is a consultant for Ablynx, Amnis Therapeutics, Medtronic, Cerenovus/J&J, Rapid Medical and Anaconda. LY has received substantial grant funding from the National Medical Research Council (NMRC), Singapore and substantial support from the ministry of health (MOH), Singapore. CK is proctor for Acandis. FD is consultant for Acandis. RC is consultant and/or proctor for BALT, Stryker, Microvention, Rapid Medical, Siemens Medical Systems. CS is consultant and/or proctor for Acandis, Balt, and Rapid Medical. Publisher Copyright: © Copyright © 2020 Meyer, Fiehler, Thomalla, Krause, Lowens, Rothaupt, Kim, Heo, Yeo, Andersson, Kabbasch, Dorn, Chapot, Stracke and Hanning.

PY - 2020/2/14

Y1 - 2020/2/14

N2 - Background and Purpose: Recently, acute intracranial stenting (ICS) has gained more interest as a potential bailout strategy for large vessel occlusions (LVO) that are refractory to thrombectomy. However, there are currently no reports on ICS in patients with moderately severe stroke discussing the question if implementing a permanent stent is feasible and leads to improved recanalization after failed thrombectomy. Methods: We analyzed a large multicenter database of patients receiving ICS for anterior circulation LVO after failed thrombectomy. Inclusion criteria were defined as: Moderately severe stroke (National Institute Health Stroke Scale (NIHSS) ≤9 on admission), anterior circulation LVO, acute ICS after failed stent retriever MT. Primary endpoint was the rate of improved successful recanalization after ICS defined as a modified Thrombolysis In cerebral Infarction (mTICI) score≥2b. Favorable neurological outcome was defined as an early neurological improvement (ENI) of 4 points or reaching 0 with respect to baseline NIHSS. Results: Forty-one patients met the inclusion criteria. A median of 2 retrievals were performed (IQR 1–4) prior decision-making for ICS. ICS led in 90.2% (37/41) of cases to a final mTICI≥2b with significant improvement (p < 0.001) after the last retrieval attempt. The median NIHSS decreased (p = 0.178) from 7 (IQR 3.5–8) on admission to 2.5 (IQR 0–8.25) at discharge. ENI was observed in 47.4% (18/38). sICH occurred in 4.8% (2/41). Conclusion: ICS after failed thrombectomy appears to effectively improve recanalization rates in patients with moderately severe strokes. Thus, ICS should be considered also for patients with baseline NIHSS ≤9 if thrombectomy fails.

AB - Background and Purpose: Recently, acute intracranial stenting (ICS) has gained more interest as a potential bailout strategy for large vessel occlusions (LVO) that are refractory to thrombectomy. However, there are currently no reports on ICS in patients with moderately severe stroke discussing the question if implementing a permanent stent is feasible and leads to improved recanalization after failed thrombectomy. Methods: We analyzed a large multicenter database of patients receiving ICS for anterior circulation LVO after failed thrombectomy. Inclusion criteria were defined as: Moderately severe stroke (National Institute Health Stroke Scale (NIHSS) ≤9 on admission), anterior circulation LVO, acute ICS after failed stent retriever MT. Primary endpoint was the rate of improved successful recanalization after ICS defined as a modified Thrombolysis In cerebral Infarction (mTICI) score≥2b. Favorable neurological outcome was defined as an early neurological improvement (ENI) of 4 points or reaching 0 with respect to baseline NIHSS. Results: Forty-one patients met the inclusion criteria. A median of 2 retrievals were performed (IQR 1–4) prior decision-making for ICS. ICS led in 90.2% (37/41) of cases to a final mTICI≥2b with significant improvement (p < 0.001) after the last retrieval attempt. The median NIHSS decreased (p = 0.178) from 7 (IQR 3.5–8) on admission to 2.5 (IQR 0–8.25) at discharge. ENI was observed in 47.4% (18/38). sICH occurred in 4.8% (2/41). Conclusion: ICS after failed thrombectomy appears to effectively improve recanalization rates in patients with moderately severe strokes. Thus, ICS should be considered also for patients with baseline NIHSS ≤9 if thrombectomy fails.

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Intracranial Stenting After Failed Thrombectomy in Patients With Moderately Severe Stroke: A Multicenter Cohort Study

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