Safety Profile of Rescue Stenting Following Thrombectomy for Acute Basilar Artery Occlusion – PC SEARCH Registry Analysis
Ehad Afreen1, Adam Mierzwa1, Syed Zaidi2, Nameer Aladamat3, Khaled Gharaibeh4, Ashley Nelson5, Santiago Ortega Gutierrez6, Mudassir Farooqui6, Juan Vivanco-Suarez6, Ashutosh Jadhav7, Shashvat Desai8, Gabor Toth9, Anas Alrohimi7, Thanh Nguyen10, Klein Piers11, Mohamad Abdalkader10, Aditya Pandey12, Sravanthi Koduri12, Shivangi Vora13, Nirav Vora13, Mouhammad Jumaa2, Sami Al Kasab5
1Promedica, 2ProMedica Stroke Network, 3The University of Toledo, 4ProMedica Neurosciences Center, 5Medical University of South Carolina, 6University of Iowa, 7University of Pittsburgh, 8University of Pittsburgh Medical Center, 9Cleveland Clinic Foundation, 10Boston Medical College, 11Boston University, 12University of Michigan, 13Ohio Health
Objective:
Our aim was to determine efficacy and safety profile of rescue stenting following thrombectomy in a cohort of patients with acute basilar artery occlusion
Background:
Recent randomized controlled trials demonstrated clinical benefit of mechanical thrombectomy for acute basilar artery occlusion. Approximately 10% of patients undergoing mechanical thrombectomy require rescue angioplasty/ stenting due to residual underlying stenosis to main successful reperfusion
Design/Methods:
PC-SEARCH is a multi-centered retrospective registry of consecutive acute BAOs treated with thrombectomy with contributions from eight high-volume centers across the United States from July 2015 – December 2021. Patients were included in this registry if they received mechanical thrombectomy or intra-arterial thrombolysis within 24 hours of last seen well. Good clinical outcome was defined as 3 months mRS ≤ 3. Multivariate logical regression models were used to identify predictors of good clinical outcomes in patients who received rescue stenting.
Results:
Total of 336 patients were included in the analyses, of those, fifty two (6.5%) received rescue stenting. There was no difference in age, admission NIHSS or PC ASPECTS score between the stenting and non stenting groups. Good recanalization (≥TICI 2b) was achieved in 82% in the non-stent group vs 91% in the stent group, P=0.103. Forty-five percent of patients reached mRS ≤3 with overall mortality rate of 41.4% at 90 days in the non-stent group vs 44.2% in the stenting group. Similar rates of sICH were noted between the two groups (0% in rescue stenting vs. 5.4) in MT only group, p value 0.089). Multivariate analysis demonstrated similar rates of good outcome (OR 1.26, CI 0.53 - 1.964; p = 0.95) among the rescue stenting compared to non stenting group.
Conclusions:
In patients with acute basilar occlusion, rescue stenting due to underlying residual stenosis, stenting appears to be safe with similar rates of complications and favorable outcomes compared to no stenting group.