Abstract
Abstract 50: Rescue Stenting For Failed Mechanical Thrombectomy In Acute Ischemic Stroke: Systematic Review And Meta-analysis
Stroke (1970), Vol.54(S_1), p.A50
02/01/2023
DOI: 10.1161/str.54.suppl_1.50
Abstract
Byline: Aaron Rodriguez-Calienes, Univ of Iowa, Iowa city, IA; Milagros Galecio-Castillo, Univ of Iowa, Iowa City, IA; Juan Vivanco Suarez, Univ of Iowa, Iowa city, IA; Cynthia Zevallos Mau, Univ of Iowa, Iowa City, IA; Fazeel Siddiqui, Univ of Michigan, Wyoming, MI; Edgar A Samaniego, Univ of Iowa Hosps, Iowa City, IA; Mudassir Farooqui, Univ of Iowa, Iowa City, IA; Santiago Ortega-Gutierrez, Univ of Iowa, Iowa City, IA Introduction: When mechanical thrombectomy (MT) fails to achieve successful recanalization, rescue stenting (RS) has proven to be a feasible rescue therapy. However, the available evidence remains underpowered to assess its safety and efficacy. Objective: To compare the safety and efficacy of RS versus routine medical treatment in patients who failed MT using an aggregated metanalysis. Methods: A systematic review was performed in Scopus, Embase, Medline, and Web of Science from inception to July 2022 for all studies that tested the safety and efficacy of RS after failed MT. Outcomes of interest included an mRS score of 0-2 at 90 days, successful recanalization (mTICI 2b-3) after RS, symptomatic intracranial hemorrhage (sICH), and all-cause mortality at 90 days. A random-effects meta-analysis was performed between the RS and medical treatment arm to calculate pooled odds ratios (OR) for each outcome. Statistical heterogeneity across studies was assessed with I2 statistics. Results: In total 12 studies involved 1855 participants, 729 in the RS arm and 1126 in the medical treatment arm. The pooled results indicated that RS was associated with a higher proportion of patients with an mRS score of 0-2 at 90 days (RS: 41% vs. 21%; OR = 3.27; 95% CI 2.08 - 5.16; I2 = 64%) and a decreased risk of mortality at 90 days (RS: 22.5% vs. 33.8%; OR = 0.47; 95% CI 0.32 - 0.69; I2 = 45%), compared with medical treatment after failed MT. The pooled rate of successful recanalization after RS was 87% (95% CI 82 - 91; I2 = 57%). The rate of sICH did not differ between groups (RS: 8.5% vs. 11.7%; OR = 0.85; 95% CI 0.59 - 1.20; I2 = 7%) Conclusion: RS represents a promising strategy that for maximizing recovery in acute stroke patients after first line MT fails to achieve meaningful reperfusion. However, a randomized trial using a standardized approach/technique and independently adjudicated outcomes is needed to confirm this observation.
Details
- Title: Subtitle
- Abstract 50: Rescue Stenting For Failed Mechanical Thrombectomy In Acute Ischemic Stroke: Systematic Review And Meta-analysis
- Creators
- Aaron Rodriguez-Calienes - University of IowaMilagros Galecio-Castillo - University of IowaJuan Vivanco SuarezCynthia Zevallos MauFazeel Siddiqui - University of Michigan–Ann ArborEdgar A Samaniego - University of IowaMudassir Farooqui - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.54(S_1), p.A50
- Publisher
- Lippincott Williams & Wilkins, WK Health
- DOI
- 10.1161/str.54.suppl_1.50
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 02/01/2023
- Description audience
- Academic
- Academic Unit
- Neurosurgery; Radiology; Neurology; Iowa Neuroscience Institute
- Record Identifier
- 9984367715802771
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