Recanalization efficiency of rescue stenting for embolic cerebral artery occlusion with difficulty in thrombectomy

Abstract:

Objective To explore whether rescue stenting can efficiently recanalize embolic cerebral artery occlusion after failed thrombectomy or iatrogenic cerebral artery embolism in nerve intervention.Methods The clinical data of 6 patients with failed thrombectomy and 4 patients with iatrogenic cerebral middle and distal artery embolism received rescue stenting in Shanghai Ninth People's Hospital，Shanghai Jiaotong University School of Medicine from January 2020 to November 2021 were analyzed retrospectively. The preoperative National Institutes of Health Stroke Scale（NIHSS），the NIHSS score at 24 h after procedure，the postoperative stent patency，the type of hemorrhagic transformation and prognosis were recorded.Results There were 6 cases receiving rescue stenting after failed thrombectomy for embolic occlusion of middle cerebral artery. All of them（100%） had modified thrombosis in cerebral infarction score（mTICI 2b-3），3 cases had hemorrhagic transformation after the surgery （1 case of PH2 type，and 2 cases of HI2 type），5 cases （83%） had patent bleeding at 24 h after operation，one did not undergo repeated angiography examination，and 3 cases（50%） died during hospitalization. Among the 4 cases of iatrogenic cerbral middle and distal artery occlusion，one was primarily high vertebrobasilar artery stenosis，and had right anterior inferior cerebellar artery embolism during the stenting. The recanalization occurred after the rescue stenting. At 24 h after operation，all stents were unobstructed，no patients had no cerebral hemorrhage，and the prognosis was good after 3 months （modified Rankin score，mRS： 1 point）. Three cases had iatrogenic ipsilateral anterior cerebral artery embolism during thrombectomy for middle cerebral artery embolism，the blood flow recovered immediately after direct stent implantation，among which，one case underwent cerebral computed tomography angiography（CTA） at 24 h after operation showing the patent stent and hemorrhagic transformation（type HI2）. The other 2 cases did not have repeated examination because of disease severity.Conclusion Rescue stenting can rapidly and efficiently recanalize embolic occlusion of cerebral artery due to failed thrombectomy or iatrogenic middle and distal embolism，but its effectiveness and safety need to be further studied.