Abstract
Objective
In patients with large vessel occlusion, successful reperfusion is a predictor of favorable outcome. However, patients with underlying intracranial atherosclerotic disease (ICAD) show higher rates of immediate reocclusion, frequently requiring rescue stenting. We aimed to investigate the safety, efficacy, and outcome of acute stenting in acute stroke patients with underlying ICAD.
Methods
Prospective databases from two centers between 2012 and 2021 were reviewed. Adult patients who underwent ICAD-related acute intracranial stenting, after mechanical thrombectomy (MT) were included. Clinical and procedural data, technical success measured by Modified Thrombolysis in Cerebral Infarction score, periprocedural complications, stent restenosis, and follow up mRS at three months were evaluated.
Results
During a 10-year period, a total of 96 patients with acute stroke and intracranial atherosclerotic steno-occlusive lesions underwent stenting after MT. Mean age was 63 (SD 14) and 54 patients were male (56.3%). Successful reperfusion (TICI ≥ 2b) was achieved in 86 patients (89.6%) following rescue stenting; favorable clinical outcome (mRS < 3) was observed in 32 patients (37.6%). Symptomatic intracranial hemorrhage and mortality were observed in 9.5% and 22.4% of patients, respectively. Multivariate regression yielded older age (OR: 0.477, 95% CI: 0.933–0.999, p=0.046) as an independent negative predictor of favorable functional outcome after acute intracranial stenting.
Conclusion
Our results suggest that acute intracranial stenting is safe and effective as a rescue treatment after MT in acute stroke patients with underlying ICAD. Younger age was found as an independent predictor of good outcome. Nevertheless, ICAD still carries a high mortality and poor functional clinical outcome.
Keywords: Thrombectomy, intracranial atherosclerosis, stent
Introduction
Intracranial atherosclerotic disease (ICAD) accounts for up to 50% of all strokes and transitory ischemic attacks (TIA) in the Asian population and 10% of all ischemic strokes and TIA in Europe. 1 Moreover, ICAD is associated with a risk of recurrent stroke as high as 15% per year.1–3 Patients with symptomatic stenosis higher than 70% have a high rate of recurrent stroke despite optimal medical therapy. 2 Importantly, randomized clinical trials failed to show superiority of intracranial stenting in addition to medical management compared to medical treatment alone for management of ICAD largely due to high peri-procedural stroke.4,5
Even less is known about the best treatment for ICAD presenting with emergent large vessel occlusion (LVO) and found to have residual high-grade stenosis, frequently leading to rescue intracranial stenting to maintain reperfusion.6–9 Concerns have been raised regarding the safety of acute intracranial stenting, namely an increased risk of hemorrhage, the occurrence of perforator stroke and stent occlusion.8,10,11 Nevertheless, recent studies have shown potential benefits in acute stenting of intracranial stenosis in the setting of acute stroke, and reasonable safety profiles.2,12–14
This study describes a two-center experience with rescue intracranial stenting in acute stroke patients with underlying ICAD and expand on the technical and safety profiles of rescue stenting.
Methods
Patient population
The prospectively maintained databases from two participating comprehensive stroke centers, one in Portugal and the other one in USA, from 2012 to 2021 were retrospectively reviewed. We included adult patients with acute symptomatic intracranial LVO who underwent mechanical thrombectomy (MT) and were found to have underlying ICAD, requiring rescue treatment with stenting. We defined ICAD as observable plaque at occlusion site post-thrombectomy or a residual stenosis >50% after thrombectomy. Patients with embolic occlusion or non-atherosclerotic stenosis, such as arterial dissection and vasculitis, were excluded based on a comprehensive evaluation conducted during their hospital stay. A documented cardiac embolic source, multiple bead-like irregularities of small vessels, or the presence of an intimal flap were exclusion criteria.
We retrospectively collected clinical and imaging data regarding patients’ demographics, comorbidities, stroke severity as measured by the National Institute of Health Stroke Scale (NIHSS) at presentation, type of stent used, whether balloon angioplasty was performed, technical success measured by Modified Thrombolysis in Cerebral Infarction 15 score, periprocedural complications, stent restenosis, and follow-up mRS at three months. Institutional Ethics Committees in both centers approved this retrospective study and also waived informed consent due to its retrospective nature.
Endovascular treatment protocol
All patients were evaluated by a stroke physician. Imaging assessment on admission included computed tomography (CT) and CT-angiography, in addition to CT perfusion. Eligible patients received IV tissue plasminogen activator (rtPA) and then underwent endovascular treatment.
A transfemoral approach was performed in most patients. In patients with extreme tortuosity of the supra-aortic vessels, a transradial/brachial approach was used. MT was performed using different approved modalities, including aspiration thrombectomy, stent retrievers, or a combined technique. Stenting with or without angioplasty was performed when there was severe (>70%) residual stenosis after MT and/or if reocclusion occurred in the follow-up runs in the 10 min after thrombectomy. A self-expanding stent (Wingspan®, Boston Scientific) was used in most cases, followed by Neuroform atlas (Stryker Neurovascular). Other stents were used according to the operator's preference (Enterprise®, Codman; LVIS Jr®, MicroVention-Terumo; Neuroform EZ®, Boston Scientific, Solitaire®, Medtronic). All patients undergoing acute stenting underwent one of two protocols: (1) a loading dose of aspirin (500 mg) and ticagrelor (180 mg) or clopidogrel (300 mg), and a glycoprotein IIb/IIIa inhibitor (abciximab 10 mg or eptifibatide 8 mg IV bolus), followed by aspirin 150 mg daily and ticagrelor 90 mg twice daily; (2) tirofiban weight base continuous infusion at the time of stent deployment, and continued for 2 h after loading dose of aspirin 650 mg and ticagrelor 180 mg followed by aspirin 325 mg daily and ticagrelor 90 mg twice daily. Patients underwent conscious sedation or general anesthesia, chosen according to the patient's neurological status and operator preference. Successful recanalization was defined as achieving a modified TICI grade 2b-3.
Clinical and imaging follow up
Transcranial Doppler (TCD) or CT angiography was performed in all patients within the first 24 h after endovascular treatment to evaluate stent patency. Besides, a CT or MRI scan was also performed in all patients in the first 24-h after the procedure to assess the extent of the infarcted tissue and screen for procedure-related complications. Dual antiplatelet therapy protocols included: aspirin 150 mg and clopidogrel 75 mg or ticagrelor 90 + 90 mg for 6–8 weeks or aspirin 325/81 mg and clopidogrel 75 mg or ticagrelor 90 + 90 mg, respectively, for 3–6 months, after which a single antiplatelet regimen was left permanently. Along the timeline of the study, there was a shift from clopidogrel to ticagrelor, and the present protocols at both institutions include an association of aspirin and ticagrelor.
Platelet activity testing, which could provide valuable insights into the individual patient's response to antiplatelet agents, was not part of our study protocol.
Symptomatic intracranial hemorrhage (sICH) was defined as any hemorrhage with symptoms leading to an increase of at least four points in the NIHSS. 16 New symptomatic ischemic events were defined as any new sudden focal neurological deficit sustained for a duration of >24 h, documented on head CT or MR. This specification in the imaging criteria was made to exclude neurological hemodynamic fluctuations or TIAs.
Patients were assessed at follow-up appointments by an experienced stroke physician, and their functional outcome was assessed by the modified Rankin Scale (mRS) at three months after discharge. A favorable outcome was defined as an mRS score of 0–2.
Follow-up imaging protocol included TCD at 1, 3, 6, and 12 months post-procedure to evaluate stent patency. Stent restenosis was defined as residual stenosis ≥ 50% of the parent vessel diameter. 17
Statistical analysis
All continuous variables were reported as mean ± standard deviation (SD). Categorical variables were reported as a percentage. Difference between groups tested using Pearson's Chi-squared test for categorical data and linear model ANOVA for continuous variables. Binary outcomes were defined: (1) functional clinical outcome (good [mRS 0–2] and poor [mRS 4–6]); (2) sICH occurrence after procedure (yes/no); (3) intra-procedure stent occlusion (yes/no); (4) post-procedure stent occlusion (yes/no); (5) overall (intra and post-procedure) stent occlusion (yes/no); and (6) new symptomatic ischemic events after procedure (yes/no). We investigated the univariate and multivariable correlations between functional outcomes and sICH occurrence after procedure and variables of interest as covariates which included: age, sex, hypertension, atrial fibrillation, diabetes mellitus (DM), hyperlipidemia, previous ischemic stroke, NIHSS on admission, pre-stroke mRS, IV thrombolytic, occlusion site, and postprocedural TICI score. The probability of favorable functional outcomes (mRS 0–2) at 90 days was estimated using a binomial logistic regression model. At logistic regressions, crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were reported for each parameter. P-value less than 0.05 was considered significant and all tests were two-tailed. All statistical analyses were conducted using JAMOVI open-source R-based statistical software version 2.3.18.
Results
Patients baseline characteristics
During a 10-year period, a total of 2858 patients underwent MT at the two centers. From these, 96 patients with acute stroke and intracranial atherosclerotic steno-occlusive lesions underwent acute stenting.
Baseline and procedural characteristics are shown in Table 1. The mean age of patients was 63.3 (±14.2) years old, and 54 (56.3%) patients were male. The most frequent comorbidities were hypertension (70.8%), hyperlipidemia (53.3%), smoking history (45.8%), and DM (31.3%).
Table 1.
Baseline characteristics and outcomes of the study population.
| All patients (n = 96 patients) | |
|---|---|
| Patients baseline characteristics | |
| Age, mean (SD) | 63.3 (±14.2) |
| Male sex | 54 (56.3%) |
| Diabetes | 30 (31.3%) |
| Hypertension | 68 (70.8%) |
| Atrial Fibrillation | 7 (7.3%) |
| Hyperlipidemia | 51 (53.3%) |
| Congestive heart failure | 5 (5.2%) |
| Smoking | |
| Never | 50 (52.1%) |
| Prior/formal | 17 (17.7%) |
| Current smoker | 27 (28.1%) |
| Pre-stroke mRS scores | |
| mRS 0–2 | 76 (79.2%) |
| mRS 3–5 | 7 (7.2%) |
| Admission NIHSS, mean (SD) | 14.4 (8.5) |
| Lesion location | |
| Anterior circulation | 62 (64.6%) |
| Posterior circulation | 34 (35.4%) |
| Occluded vessel | |
| ICA | 15 (15.6%) |
| M1 | 40 (41.6%) |
| M2 | 7 (7.3%) |
| BA | 29 (30.2%) |
| VA | 3 (3.1%) |
| PCA | 2 (2.1%) |
| ASPECTS, mean (SD) | 8.4 (1.6) |
| IV tPA | 29 (30.2%) |
| Procedural details | |
| Symptom onset to groin time (min), mean (SD) | 756.8 (±775.3) |
| Puncture to successful recanalization time (min), mean (SD) | 62.6 (±51.4) |
| Balloon angioplasty | 62 (64.6%) |
| Stent type | |
| Enterprise® | 5 (5.2%) |
| LVIS Jr® | 7 (7.3%) |
| Neuroform Atlas® | 29 (30.2%) |
| Neuroform EZ® | 1 (1.0%) |
| Solitaire® | 5 (5.2%) |
| Wingspan® | 49 (51.0%) |
| Successful recanalization (TICI ≥ 2b) | 86 (89.6%) |
| Length of in-hospital stay (days), mean (SD) | 10.3 (9.6) |
| Procedure and post-procedure complications | |
| Stent occlusion during procedure | 7 (7.3%) |
| Stent occlusion after procedure | 15 (15.6%) |
| Overall stent occlusion | 20 (20.8%) |
| sICH | 9 (9.5%) |
| New symptomatic ischemic events | 9 (9.4%) |
SD: standard deviation.
Mean NIHSS at admission was 14 (±8.5). Sixty-two patients (64.6%) had an anterior circulation LVO, whereas 34 patients (35.4%) had posterior circulation LVO. The most common occlusions were the M1 segment of the MCA (41.6%—40 patients), and the basilar artery (30.2%—29 patients). ASPECTS score median was 8 (range 4–10) for patients with anterior circulation stroke.
Intravenous recombinant tPA prior to the recanalization procedure was administered in 29 patients (30.2%).
Procedural details
Every patient in our cohort underwent MT, and rescue stenting in the acute phase of stroke, with a mean symptom onset to groin time of 12.6 h (±12.9 h). Sixty-two patients (64.6%) underwent balloon angioplasty during the procedure (Table 1), with 46 undergoing pre-stenting angioplasty, 6 having both pre- and post-stenting angioplasty, and 10 only undergoing post-stenting angioplasty.
The most used stent was the Wingspan® 49 patients (51%). The Neuroform Atlas® was used in 29 patients (30.2%), the LVIS Jr®stent in 7 patients (7.3%), the Solitaire® stent in 5 patients (5.2%), the Enterprise® stent in 5 patients (5.2%), and the Neuroform EZ® stent in 1 patient (1.0%).
Mean time from puncture to successful recanalization was 60 min (±51 min), and successful revascularization (TICI ≥ 2b) was achieved in 86 patients (89.6%) (Figure 1).
Figure 1.
Illustrative case of a 72-year-old woman, with a personal history of hyperlipidemia, presented with a left M1 occlusion (A). Thrombolysis in cerebral infarction (TICI) 3 revascularization was obtained after one aspiration with ACE 68® (Penumbra, Inc.), revealing focal stenosis of the M1 segment in relation to atherosclerotic disease (B). After reocclusion a decision was made to deploy a stent. AP run after deploying Wingspan ® stent, showing full recanalization and smoothening of M1 wall irregularities (C).
Complications and outcomes
Of the 95 patients, 9 (9.5%) had sICH in the post-procedural phase (Table 1). Patients with hyperlipidemia had a trend for less sICH (Supplemental Table 1). On univariate regression, we could not identify any predictors of sICH after acute intracranial stenting (Supplemental Table 2).
Intra-procedural stent occlusion was observed in 7 of the 96 patients (7.3%, Table 1) and it was associated with lower final TICI scores (p < 0.001, Supplemental Table 3). Delayed stent occlusion was reported in 15 patients (15.6%, Table 1). Two of these patients also had an intra-procedural stent occlusion that was recanalized. Stent occlusion at any time was observed in a total of 20 patients (20.8%, Table 1).
New ischemic events after procedure occurred in 9 patients (9.4%, Table 1), and these were more frequent in patients with intra-procedural stent occlusion (p = 0.039, Supplemental Table 4), and in patients with lower TICI scores (p = 0.01, Supplemental Table 4). Although without significance, there was also a trend for the occurrence of new ischemic events in patients with delayed stent occlusion.
Functional outcome (mRS) at 90 days was available for 85 of the patients (88.5%). Thirty-two patients (37.6%) had a good clinical outcome (mRS 0–2); in the subgroup of patients with anterior circulation LVO, 23 of the 57 patients (40.4%) had a favorable outcome, versus 9 of the 28 patients (32.1%) with posterior circulation LVO. Mortality was 22.4% (19 patients), including 9 patients with anterior circulation LVO and 10 patients with posterior circulation LVO.
There was a significant association between good functional outcome and younger age (p = 0.008), lower pre-stroke mRS (p = 0.011), no history of hypertension (p = 0.008), no history of hyperlipidemia (p = 0.035) (Table 2).
Table 2.
Comparison of baseline characteristics between patients with good (mRS 0–2) and poor (mRS 3–6) functional clinical outcome.
| Poor clinical outcomes mRS scores 3–6 (N = 53) | Good clinical outcomes mRS scores 0–2 (N = 32) | Total (N = 85) | p-value | |
|---|---|---|---|---|
| Patients baseline characteristics | ||||
| Age, mean (SD) | 65.8 (11.7) | 57.2 (17.5) | 62.5 (14.7) | 0.008 |
| Gender | 0.137 | |||
| Female | 27 (50.9%) | 11 (34.4%) | 38 (44.7%) | |
| Male | 26 (49.1%) | 21 (65.6%) | 47 (55.3%) | |
| Diabetes | 20 (37.7%) | 7 (21.9%) | 27 (31.8%) | 0.128 |
| Hypertension | 45 (84.9%) | 19 (59.4%) | 64 (75.3%) | 0.008 a |
| Atrial fibrillation | 5 (9.4%) | 1 (3.1%) | 6 (7.1%) | 0.271 a |
| Hyperlipidemia | 34 (64.2%) | 13 (40.6%) | 47 (55.3%) | 0.035 a |
| Smoking | 0.633 a | |||
| Never | 26 (50%) | 16 (50%) | 42 (50%) | |
| Prior/formal | 12 (23.1%) | 5 (15.6%) | 17 (20.2%) | |
| Current smoker | 14 (26.9%) | 11 (34.4%) | 25 (29.8%) | |
| Pre-stroke mRS, mean (SD) | 1.1 (1.5) | 0.1 (0.3) | 0.8 (1.3) | 0.011 b |
| Admission NIHSS, mean (SD) | 15.2 (8.3) | 13.4 (8.5) | 14.5 (8.4) | 0.357 b |
| Lesion location | 0.463 a | |||
| Anterior circulation | 34 (64.2%) | 23 (71.9%) | 57 (67.1%) | |
| Posterior Circulation | 19 (35.8%) | 9 (28.1%) | 28 (32.9%) | |
| ASPECTS, mean (SD) | 8.4 (1.6) | 8.5 (1.7) | 8.4 (1.6) | 0.745 b |
| IV tPA | 13 (24.5%) | 12 (37.5%) | 25 (29.4%) | 0.203 a |
| Procedural details | ||||
| Symptom onset to groin time (min), mean (SD) | 876.7 (930.4) | 622.1 (439.0) | 794.4 (810.1) | 0.228 b |
| Puncture to successful recanalization time (min), mean (SD) | 58.4 (44.9) | 55.8 (44.3) | 57.5 (44.4) | 0.804 b |
| Balloon angioplasty | 27 (50.9%) | 15 (46.8%) | 0.89 | |
| Stent type | 0.675 a | |||
| Enterprise® | 2 (3.8%) | 1 (3.1%) | 3 (3.5%) | |
| LVIS Jr® | 5 (9.4%) | 1 (3.1%) | 6 (7.1%) | |
| Neuroform Atlas® | 16 (30.2%) | 12 (37.5%) | 28 (32.9%) | |
| Neuroform EZ® | 0 (0%) | 1 (3.1%) | 1 (1.2%) | |
| Solitaire® | 3 (5.7%) | 1 (3.1%) | 4 (4.7%) | |
| Wingspan® | 27 (52.0%) | 16 (50%) | 42 (49.4%) | |
| Successful recanalization (TICI ≥ 2b) | 47 (88.7%) | 30 (93.8%) | 77 (90.5%) | 0.423 a |
| Length of stay (days), mean (SD) | 13.1 (11.4) | 6.5 (4.1) | 10.3 (9.6) | 0.015 b |
Pearson's Chi-squared test.
Linear model ANOVA (all continuous variables were reported as mean (SD)).
In univariate logistic regression, older age (OR: 0.959, 95% CI: 0.928–0.991, p = 0.012), history of hypertension (OR: 0.260, 95% CI: 0.093–0.729, p = 0.010), and history of hyperlipidemia (OR: 0.382, 95% CI: 0.155–0.942, p = 0.037) were associated with decreased odds of favorable functional outcome at 90 days (Table 3). Multivariate regression yielded age (OR: 0.477, 95% CI: 0.933–0.999, p=0.046) as an independent negative predictor of good functional outcome after acute intracranial stenting. We could not find any independent predictors of stent reocclusion.
Table 3.
Univariate and multivariate analysis of predictors of good clinical outcomes (mRS 0–2) at 90 days.
| Factor | Univariate regression | Multivariate regression | ||||||
|---|---|---|---|---|---|---|---|---|
| 95% confidence interval | 95% confidence interval | |||||||
| p-value | Odds ratio | Lower | Upper | p-value | Odds ratio | Lower | Upper | |
| Age | 0.012 | 0.959 | 0.928 | 0.991 | 0.046 | 0.477 | 0.933 | 0.999 |
| Sex (ref: male) | 0.139 | 0.504 | 0.204 | 1.250 | ||||
| Atrial fibrillation | 0.295 | 0.310 | 0.035 | 2.780 | ||||
| Hypertension | 0.010 | 0.260 | 0.093 | 0.729 | 0.255 | 0.477 | 0.133 | 1.707 |
| Hyperlipidemia | 0.037 | 0.382 | 0.155 | 0.942 | 0.319 | 0.568 | 0.187 | 1.727 |
| Diabetes | 0.132 | 0.462 | 0.169 | 1.260 | ||||
| NIHSS on admission | 0.353 | 0.975 | 0.924 | 1.030 | ||||
| mRS 0–2 on admission | 0.575 | 1.684 | 0.272 | 10.43 | ||||
| IV thrombolytic | 0.206 | 1.846 | 0.714 | 4.777 | ||||
| Occlusion site (ref: post. cir) | 0.464 | 1.428 | 0.550 | 3.710 | ||||
| TICI 2b-3 (ref: TICI 0-2a) | 0.430 | 1.957 | 0.370 | 10.34 | ||||
Discussion
We present a two-center retrospective study on rescue intracranial stenting in patients with acute stroke undergoing MT in the setting of ICAD. Our results show that acute stenting in ICAD-related acute stroke is associated with favorable functional outcomes. Nevertheless, we had a 9.5% occurrence of sICH and a 9.4% rate of recurrent ischemic events.
MT is now standard of care for acute ischemic stroke due to LVO. 18 Recanalization failure rate ranges between 14% and 41% in the literature, often leading to poor functional outcomes, including mortality rates that range from 19% to 49% and lower rates of functional independence at 90 days (mRS scores 0–2) ranging from 7% to 22%.19–23 ICAD LVO represents the most common reason for failed MT. 24 In patients with intracranial atherosclerosis related LVO, increased thrombogenicity associated with an acutely inflamed atheromatous plaque result in higher chances of immediate arterial re-occlusion after treatment.19,21 Additional rescue stenting with or without angioplasty was reported in patients with ICAD related LVO, 25 achieving successful recanalization in up to 86%,21,26–29 with improved clinical outcomes and low rates of complications.27,30,31 In a recent meta-analysis comprising a total of 352 patients with intracranial LVO due to underlying ICAD and failed MT, rescue intracranial stenting had similar favorable clinical outcome without added risks of sICH. 32 Our results are in line with these studies, confirming high rates of successful recanalization (89.6%), with a favorable clinical outcome at 90 days in 38% of our cohort. Functional independence at three months in our cohort was in line with previous reports of 29–66.7% good clinical outcome at three months.23,26–28,33–35 Our mortality rate of 22.4% is also comparable to other reported series.21,23,33,35 The results obtained may have been influenced by a mean duration of 12 h from the onset of symptoms to groin puncture, which could possibly reflect our elderly population. This particular demographic group tends to exhibit a higher prevalence of arterial collaterals, presenting with neurological symptoms that fluctuate over time, ultimately leading to a delay from symptom onset to hospital presentation.
In our study, older age was the only predictor of poor outcome among patients receiving rescue stenting. These findings are similar to those described by Stracke et al., 27 who also found higher age and higher pre-morbid mRS as predictors of a poor outcome. Previous studies have shown a higher incidence of post-procedural complications in elderly patients undergoing intracranial stenting. 36 Factors that may contribute to worse outcomes in elderly patients include comorbidities, such as hypertension and hyperlipidemia.
Complications associated with acute stenting in our cohort included stent occlusion during or after procedure (20.8%), sICH (9.5%), and new ischemic lesions (9.4%). Stent occlusion rates were similarly reported by Forbrig et al., 33 who found 18% of stent occlusion within the first 24 h. Acute stenting may further damage the inflamed plaque, and promote thrombosis, 37 which adds to variability in patients response to platelet inhibitors. 38 Stent occlusion at any time is closely related to the occurrence of new ischemic lesions, that impact prognosis, with reported rates of recurrent ischemic stroke as high as 35% in the literature.4,5 A concern in acute intracranial stenting is the need for a loading dose of antiplatelet agents, which may increase the risk of intracranial hemorrhage. However, recent studies have not shown increased sICH in acute ICAD related LVO requiring rescue stenting.39,40 We could not find any independent predictors of sICH, due to the small number of patients with sICH in our cohort.
There were limitations to our study, mostly due to its retrospective nature. The decision for hyperacute stenting was at discretion of the operator, which may have created a potential selection bias. Antiplatelet protocols have changed over the course of the years of the study, and follow-up was limited to 3 months, with 10% loss to follow-up in a relatively small series (median follow up period of 90 days, ranging from 3 days to 3326 days). Another significant limitation of our study is the low procedure volume, with each center treating an average of five patients annually throughout the study duration. Our study also has strengths, namely the long-term inclusion of patients, and the combination of the experience of two high-volume centers, reflecting a real-world scenario, and demonstrating that although antiplatelet protocols and device choices might differ, safety and efficacy are comparable.
Conclusion
In patients with acute stroke with underlying ICAD, rescue stenting had a low risk of sICH, comparable to MT, and was associated with 38% favorable functional outcome at three months. Younger age was an independent predictor of good outcome in these patients. Nevertheless, ICAD still carries a high mortality and poor functional clinical outcome.
Supplemental Material
Supplemental material, sj-docx-1-ine-10.1177_15910199231219849 for Acute intracranial stenting in acute ischemic stroke with underlying atherosclerosis: A two-center retrospective study by Sofia Bettencourt, Muhammed A Essibayi, Mariana Baptista, Patrícia Ferreira, João Reis, Alejandro M Spiotta, Sami Al Kasab and Isabel Fragata in Interventional Neuroradiology
Footnotes
Author contributions: Conceptualization and methodology: Isabel Fragata, Sami Al Kasab; conceptual and technical guidance: Isabel Fragata, João Reis; data collection: Sofia Bettencourt, Mariana Baptista, Patrícia Ferreira, Muhammed Amir Essibayi, Alejandro M. Spiotta; statistical analysis: Muhammed Amir Essibayi; writing—original draft preparation: Sofia Bettencourt; review and editing: Sami Al Kasab, Isabel Fragata. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical approval: All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
Informed consent: Institutional Ethics Committees in both centers waived informed consent due to the retrospective nature of this study. The data included in the manuscript has been all de-identified.
ORCID iDs: Sofia Bettencourt https://orcid.org/0000-0003-2553-6349
Muhammed A Essibayi https://orcid.org/0000-0001-8325-2382
Isabel Fragata https://orcid.org/0000-0002-7037-7458
Supplemental material: Supplemental material for this article is available online.
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Supplementary Materials
Supplemental material, sj-docx-1-ine-10.1177_15910199231219849 for Acute intracranial stenting in acute ischemic stroke with underlying atherosclerosis: A two-center retrospective study by Sofia Bettencourt, Muhammed A Essibayi, Mariana Baptista, Patrícia Ferreira, João Reis, Alejandro M Spiotta, Sami Al Kasab and Isabel Fragata in Interventional Neuroradiology