Rescue stent placement following a failed thrombectomy procedure has demonstrated “good outcomes” and a low risk of clinically significant bleeding in a multiethnic cohort of acute ischaemic stroke patients from the Middle East, Africa and Asia. Writing in the Journal of Vascular and Interventional Radiology (JVIR), researchers conclude that their results are “similar” to those seen with post-thrombectomy rescue stenting in the published literature.
Yahia Imam (Hamad Medical Corporation, Doha, Qatar) and colleagues initially note that, while mechanical thrombectomy has “revolutionised” stroke therapy in recent years, rescue stent placement following an unsuccessful thrombectomy “remains controversial”—particularly for Asian patients, in whom intracranial atherosclerotic disease (ICAD) is more prevalent and is believed to contribute more significantly to occurrences of re-occlusion versus in Western populations.
As such, the authors of the JVIR study conducted a retrospective, observational review of a multiethnic stroke database to evaluate the safety and effectiveness of rescue stenting in acute stroke patients with a large vessel occlusion (LVO) refractory to a thrombectomy procedure.
Their primary outcomes included incidence of intracranial haemorrhage (ICH), recanalisation score, and favourable prognosis (modified Rankin scale [mRS] score ≤2), at 90 days. Imam and colleagues also detail that, after stent placement, an “aggressive” antiplatelet protocol was followed with glycoprotein IIb/IIIa infusion in all patients included in the analysis.
The review drew comparisons between patients from the Middle East and North Africa (MENA) region, and those from other regions. Fifty-five patients (87% men; mean age, 51.3 years) were ultimately included; 32 were from South Asia (58%), 12 from the MENA region (22%), nine from Southeast Asia (16%), and two from elsewhere (4%; West Africa and East Asia).
The authors report that successful recanalisation (modified thrombolysis in cerebral infarction [mTICI] score 2b/3) was achieved in 43 patients (78%), while symptomatic ICH occurred in two patients (4%). A favourable outcome at 90 days was also seen in 26 of the 55 patients (47%).
Imam and colleagues further detail that—apart from a significantly higher average age (mean, 62.8 years vs. 48.1 years) and greater coronary artery disease burden (four [33%] vs. one [2%], p<0.05)—MENA patients demonstrated risk factors, stroke severity, recanalisation rates, ICH rates, and 90-day outcomes, that were all similar to those seen in patients from South and Southeast Asia.
Their findings within a multiethnic cohort of MENA and South Asian patients are therefore “comparable” to prior reports from East Asia, the authors aver, and constitute level-three evidence that rescue stent placement may be deemed a “viable option” in cases of refractory LVO due to probable atherosclerosis in acute ischaemic stroke patients. Utilisation of aggressive post-stent placement platelet inhibition was comparably safe and effective as well, Imam and colleagues state.
