TY - JOUR
T1 - Rescue Therapy for Failed Mechanical Thrombectomy in Acute Ischemic Stroke
T2 - A Pooled Analysis of the Society of Vascular and Interventional Neurology Registry
AU - Rodriguez-Calienes, Aaron
AU - Siddiqui, Fazeel M.
AU - Galecio-Castillo, Milagros
AU - Mohammaden, Mahmoud H.
AU - Dolia, Jaydevsinh N.
AU - Grossberg, Jonathan A.
AU - Pabaney, Aqueel
AU - Hassan, Ameer E.
AU - Tekle, Wondwossen G.
AU - Saei, Hamzah
AU - Miller, Samantha
AU - Majidi, Shahram
AU - T. Fifi, Johana
AU - Valestin, Gabrielle
AU - Siegler, James E.
AU - Penckofer, Mary
AU - Zhang, Linda
AU - Sheth, Sunil A.
AU - Salazar-Marioni, Sergio
AU - Iyyangar, Ananya
AU - Nguyen, Thanh N.
AU - Abdalkader, Mohamad
AU - Linfante, Italo
AU - Dabus, Guilherme
AU - Mehta, Brijesh P.
AU - Sessa, Joy
AU - Jumma, Mouhammad A.
AU - Sugg, Rebecca M.
AU - Linares, Guillermo
AU - Nogueira, Raul G.
AU - Liebeskind, David S.
AU - Haussen, Diogo C.
AU - Ortega-Gutierrez, Santiago
N1 - Publisher Copyright:
© 2024 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.
PY - 2024/8
Y1 - 2024/8
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85193403319&partnerID=8YFLogxK
U2 - 10.1002/ana.26967
DO - 10.1002/ana.26967
M3 - Article
C2 - 38752428
AN - SCOPUS:85193403319
SN - 0364-5134
VL - 96
SP - 343
EP - 355
JO - Annals of Neurology
JF - Annals of Neurology
IS - 2
ER -