1Mohammad J H Elhissi
1Hamad Medical Corporation
Timely restoration of blood flow is the most effective manoeuvre for salvaging ischemic brain tissue that is not already infarcted. Nearly one-third of patients with mechanical thrombectomy are left with failed recanalization, re-occlusion or hemodynamically significant residual stenosis immediately post thrombectomy.
We present our experience, as the national institute of the state of Qatar, of salvage stenting after failed thrombectomy in acute stroke management.
Material(s) and Method(s):
Retrospective analysis of patients who underwent salvage stenting was conducted. Multiple factors were analysed; patient-factors (gender, comorbidities), stroke-factors (baseline NIHSS, site of occlusion), procedure-factors (puncture-to-recanalization time, mTICI score), and outcomes (re-occlusion rate, mortality, post-procedure hemorrhage, 90-days mRS score).
Total of 50 cases of salvage stenting were performed with male-to-female ratio of 43:7. Hypertension (64%) and smoking (48%) were the most encountered risk factors.
Most occlusions were at M1 level (76%) followed by M2 level (10%). Patients presented with median baseline NIHSS of 11 (4.5 – 16).
Average puncture-to-recanalization time was 75 minutes (34-91). 54% of patients achieved final mTICI score of 3 and 36% score of 2b.
Upon short-term follow up, 28% developed re-occlusion. There was 1 case (2%) of symptomatic hemorrhage, and 4 cases of mortality (8%) due to malignant infarct or cardiac arrest.
21 patients were available at 90 days follow-up, with 81% achieving mRS ≤ 2.
Salvage stenting should be considered in patients with acute large vessel occlusion after mechanical thrombectomy failure. We believe that salvage stenting is safe and effective as it offers favourable clinical outcome, reduced mortality and comparable risk of ICH.