RT Journal Article
SR Electronic
T1 Stent Retriever AssIsted Lysis Technique with Tirofiban: A Potential Bailout Alternative to Angioplasty and Stenting
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A8374
A1 Rodrigo-Gisbert, Marc
A1 Hoferica, Matúš
A1 García-Tornel, Alvaro
A1 Requena, Manuel
A1 Rubiera, Marta
A1 Lascuevas, Marta De Dios
A1 Olivé-Gadea, Marta
A1 Diana, Francesco
A1 Rizzo, Federica
A1 Muchada, Marian
A1 Carmona, Tomás
A1 Rodriguez-Villatoro, Noelia
A1 Rodríguez-Luna, David
A1 Juega, Jesus
A1 Pagola, Jorge
A1 Hernández, David
A1 Molina, Carlos A.
A1 Tomasello, Alejandro
A1 Cognard, Christophe
A1 Ribó, Marc
YR 2024
UL http://www.ajnr.org/content/early/2024/08/15/ajnr.A8374.abstract
AB BACKGROUND AND PURPOSE: Angioplasty and stent placement have been described as a bailout technique in individuals with failed thrombectomy. We aimed to investigate Stent retriever AssIsted Lysis (SAIL) with tirofiban before angioplasty and stent placement.MATERIALS AND METHODS: Patients from 2 comprehensive stroke centers were reviewed (2020−2023). We included patients with failed thrombectomy and/or underlying intracranial stenosis who received SAIL with tirofiban before the intended angioplasty and stent placement. SAIL consisted of deploying a stent retriever through the occluding lesion to create a bypass channel and infuse 10 mL of tirofiban for 10 minutes either intra-arterially or IV. The stent retriever was re-sheathed before retrieval. The primary end points were successful reperfusion (expanded TICI 2b–3) and symptomatic intracerebral hemorrhage. Additional end points included 90-day mRS 0−2 and mortality.RESULTS: After a median of 3 (interquartile range, 2−4) passes, 44 patients received the SAIL bridging protocol with tirofiban, and later they were considered potential candidates for angioplasty and stent placement bailout (43.2%, intra-arterial SAIL). Post-SAIL successful reperfusion was obtained in 79.5%. A notable residual stenosis (>50%) after successful SAIL was observed in 45.7%. No significant differences were detected according to post-SAIL: successful reperfusion (intra-arterial SAIL, 80.0% versus IV-SAIL, 78.9%; P = .932), significant stenosis (33.3% versus 55.0%; P = .203), early symptomatic re-occlusion (0% versus 8.0%; P = .207), or symptomatic intracerebral hemorrhage (5.3% versus 8.0%; P = .721). Rescue angioplasty and stent placement were finally performed in 15 (34.1%) patients (intra-arterial SAIL 21.0% versus IV-SAIL 44%; P = .112). At 90 days, mRS 0−2 (intra-arterial SAIL 50.0% versus IV-SAIL 43.5%; P = .086) and mortality (26.3% versus 12.0%; P = .223) were also similar.CONCLUSIONS: In patients with stroke in which angioplasty and stent placement are considered, SAIL with tirofiban, either intra-arterial or IV, seems to safely induce sustained recanalization, offering a potential alternative to definitive angioplasty and stent placement.A&Sangioplasty and stentingeTICIexpanded TICIEVTendovascular treatmentIAintra-arterialICADintracranial atherosclerotic diseaseICAS-LVOintracranial atherosclerosis–related large-vessel occlusionIQRinterquartile rangeLVOlarge-vessel occlusionMTmechanical thrombectomySAILStent retriever–AssIsted LysissICHsymptomatic intracerebral hemorrhageSRstent retriever