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Ischemic stroke
Original research
Balloon-mounted versus self-expandable stent in failed neurothrombectomy: a post hoc analysis of the SAINT study
  1. Mahmoud H Mohammaden1,2,3,
  2. Pedro N Martins1,2,
  3. Hassan Aboul-Nour4,
  4. Alhamza R Al-Bayati5,
  5. Ameer E Hassan6,
  6. Wondwossen Tekle6,
  7. Johanna T Fifi7,
  8. Shahram Majidi7,
  9. Okkes Kuybu8,
  10. Bradley A Gross9,
  11. Michael Lang9,
  12. Gustavo M Cortez10,
  13. Ricardo A Hanel10,
  14. Amin Aghaebrahim10,
  15. Eric Sauvageau10,
  16. Mohamed A Tarek1,2,
  17. Mudassir Farooqui11,
  18. Santiago Ortega-Gutierrez11,
  19. Cynthia B Zevallos11,
  20. Milagros Galecio-Castillo11,
  21. Sunil A Sheth12,
  22. Michael Nahhas12,
  23. Sergio Salazar-Marioni12,
  24. Thanh N Nguyen13,
  25. Mohamad Abdalkader14,
  26. Piers Klein13,
  27. Muhammad Hafeez15,
  28. Peter Kan16,
  29. Omar Tanweer15,
  30. Ahmad Khaldi17,
  31. Hanzhou Li17,
  32. Mouhammad Jumaa18,
  33. Syed F Zaidi18,
  34. Marion Oliver18,
  35. Mohamed M Salem19,
  36. Jan-Karl Burkhardt19,
  37. Bryan Pukenas20,
  38. Nicholas Vigilante21,
  39. Mary Penckofer21,
  40. James E Siegler21,
  41. Sophia Peng22,
  42. Ali Alaraj22,
  43. Jonathan A Grossberg2,23,
  44. Raul Nogueira5,
  45. Diogo C Haussen1,2
  1. 1Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Grady Health System Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA
  3. 3Department of Neurology, South Valley University Faculty of Medicine, Qena, Egypt
  4. 4Department of Neurology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
  5. 5Department of Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA
  6. 6Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
  7. 7Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  8. 8Department of Neurology and Neurosurgery, UPMC, Pittsburgh, Pennsylvania, USA
  9. 9Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  10. 10Neurological Institute, Lyerley Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
  11. 11Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  12. 12Department of Neurology, University of Texas Health Science Center at Houston, Houston, Texas, USA
  13. 13Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
  14. 14Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
  15. 15Department of Neurosurgery, Baylor School of Medicine, Houston, Texas, USA
  16. 16Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  17. 17Department of Neurosurgery, Wellstar Health System, Marietta, Georgia, USA
  18. 18Department of Neurology, University of Toledo Medical Center, Toledo, Ohio, USA
  19. 19Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  20. 20Deaprtment of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  21. 21Cooper Neurological Institute, Cooper University Health Care, Camden, New Jersey, USA
  22. 22Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
  23. 23Department of Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Diogo C Haussen; diogo.haussen{at}emory.edu

Abstract

Background Previous studies have shown that when thrombectomy has failed, rescue intracranial stenting is associated with better clinical outcomes compared with failed reperfusion. However, comparative data regarding stent type are lacking.

Objective To compare the procedural and clinical outcomes of balloon-mounted stents (BMS) with those of self-expandable stents (SES).

Methods Retrospective analysis of a prospectively collected database from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) consortium. Patients were included if thrombectomy had failed and they then underwent rescue emergency stenting. Patients treated with SES or BMS were compared using inverse probability of treatment weighting. The primary outcome was the final reperfusion as measured by the modified Thrombolysis in Cerebral Infarction (mTICI) Scale. Safety measures included rates of symptomatic intracranial hemorrhage, procedural complications, and 90-day mortality.

Results A total of 328 patients were included. Baseline clinical and procedural characteristics were well balanced among both groups. The BMS group (n=127) had higher rates of successful reperfusion (94.5% vs 86.6%, aOR=4.23, 95% CI 1.57 to 11.37, P=0.004) and increased likelihood of higher degree of final reperfusion on the mTICI Scale (acOR=2.06, 95% CI 1.19 to 3.57, P=0.01) than the SES group (n=201). No difference in modified Rankin Scale shift (acOR=0.98, 95% CI 0.54 to 1.79, P=0.95), rates of mRS0–2 (26% vs 36%, aOR=0.93, 95% CI 0.46 to 1.88, P=0.83) and mRS0–3 (43% vs 50%, aOR=0.92, 95% CI 0.51 to 1.66, P=0.77) at 90 days were noted. Safety measures were comparable in both groups.

Conclusion The present study demonstrates higher reperfusion rates with BMS than with SES in failed thrombectomy procedures that involved rescue stenting. No differences in hemorrhagic complications or clinical outcomes were noted. Further larger controlled studies are warranted.

  • Angioplasty
  • Balloon
  • Stent
  • Thrombectomy

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2024-022795

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • X @https://x.com/Mahmoudneuro, @aboulnourh, @AlAlBayati1, @wondeasa, @Majidishahram, @DrMichaelJLang, @drnimajax, @CerebrovascLab, @mili_galecio, @MichaelNahhas, @NguyenThanhMD, @PiersKlein, @PeterKa80460001, @hanssenli, @JimSiegler, @JAGrossbergMD, @diogohaussen

    • Contributors MHM: Study conception, design of the work, interpretation of data, drafting of the manuscript. PNM: statistical analysis, critical revision of manuscript. HA-N: drafting of the manuscript. DCH: interpretation of data, critical revision of manuscript. Other co-authors: critical revision of manuscript. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MHM and DCH are guarantors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests Competing Interests Statement MHM: no disclosure, DCH is a consultant for Stryker and Vesalio and holds stock options at Viz.AI. RGN reports consulting fees for advisory roles with Stryker Neurovascular, Cerenovus, Medtronic, Phenox, Anaconda, Genentech, Biogen, Prolong Pharmaceuticals, Imperative Care and stock options for advisory roles with Brainomix, Viz-AI, Corindus Vascular Robotics, Vesalio, Ceretrieve, Astrocyte and Cerebrotech. ARA is a consultant for Stryker Neurovascular. AEH - 1. Consultant/speaker: Medtronic, Microvention, Stryker, Penumbra, Cerenovus, Genentech, GE Healthcare, Scientia, Balt, Viz.ai, Insera therapeutics, Proximie, NovaSignal and Vesalio. 2.Principal investigator: COMPLETE study Penumbra, LVO SYNCHRONISE-Viz.ai. 3.Steering committee/publication committee member: SELECT, DAWN, SELECT 2, EXPEDITE II, EMBOLISE, CLEAR. 4.Proctor: Pipeline, FRED, Wingspan, and Onyx. 5.Supported by grants from: GE Healthcare. JTF is a consultant Cerenovus, Stryker, Medtronic, Siemens, Microvention, MIVI. Stockholder in Imperative Care. TNN: advisory board Brainomix, Aruna Bio; Associate Editor of Stroke; speaker for Genentech, Kaneka. SOG: Grants-NIH-NINDS (R01NS127114-01, RO3NS126804-01), Stryker, Medtronic, Microvention, Methinks, Viz.ai. Consulting fees: Medtronic, Stryker Neurovascular. AA is consultant for Cerenovus. JB is a consultant for Q'pel Medical, Medtronic, Microvention, Stryker, Cerenovous, Balt, and Siemens Healthineers. RAH: is a consultant for Medtronic, Stryker, Cerenovus, Microvention, Balt, Phenox, Rapid Medical, and Q'Apel, advisory board for MiVI, eLum, Three Rivers, Shape Medical and Corindus. Unrestricted research grant from NIH, Interline Endowment, Microvention, Stryker, CNX. Investor/stockholder for InNeuroCo, Cerebrotech, eLum, Endostream, Three Rivers Medical Inc, Scientia, RisT, BlinkTBI, and Corindus. AA: is on advisory board for iSchema View. JES reports consulting fees from AstraZeneca, and research support from Medtronic and Philips (all unrelated to the present work). The other authors report no conflicts.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.