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, Fazeel M. Siddiqui, Milagros Galecio-Castillo, Mahmoud H. Mohammaden, Jaydevsinh N. Dolia, Jonathan A. Grossberg, Aqueel Pabaney, Ameer E. Hassan, Wondwossen G. Tekle, Hamzah Saei, Samantha Miller, Shahram Majidi, Johana T. Fifi, Gabrielle Valestin, James E. Siegler, Mary Penckofer, Linda Zhang, Sunil A. Sheth, Sergio Salazar-Marioni, Ananya IyyangarThanh N. Nguyen, Mohamad Abdalkader, Italo Linfante, Guilherme Dabus, Brijesh P. Mehta, Joy Sessa, Mouhammad A. Jumma, Rebecca M. Sugg, Guillermo Linares, Raul G. Nogueira, David S. Liebeskind, Diogo C. Haussen, Santiago Ortega-Gutierrez

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish
Pages (from-to)343-355
Number of pages13
JournalAnnals of Neurology
Volume96
Issue number2
DOIs
StatePublished - Aug 2024

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