Balloon Angioplasty with or without Stenting for Acute Intracranial Atherothrombosis.

Objectives: Due to limited evidence on the optimal strategy for acute atherothrombosis in a large intracranial vessel, we aimed to provide further evidence on the safety and efficacy of balloon angioplasty with or without stenting after failed thrombectomy. Materials & Methods: This single-center retrospective study was performed from June 2017 to February 2021. Patients with acute atherothrombosis in large intracranial vessels treated by balloon angioplasty with or without stenting after failed thrombectomy were enrolled and analyzed. Results: A total of 23 patients were recruited. All patients had a moderate stroke and the majority of them had ASPECTS ≥7 (82.6%). MCA was the most commonly affected artery (13 cases), followed by supraclinoid ICA (6 cases), and BA (4 cases). Balloon angioplasty was firstly performed in 15 cases, of which 8 cases required subsequent stenting. Intracranial stenting was firstly performed in 8 cases. Success-ful recanalization (TICI 2b-3) was achieved in 19/23 cases (82.6%) on the final angiogram. Perforated complications occurred in 1/23 cases (4.3%). Good outcome (mRS 0-2) at 90 days was achieved in 13/23 cases (56.5%) and the mortality rate was 4/23 cases (17.4%). The good clinical outcome rate was significantly higher in patients adapted with balloon angioplasty alone versus intracranial stenting. Conclusions: In the present study, balloon angioplasty with or without stenting was obsversed to be safe and efficient as a rescue therapy after failed thrombectomy for acute atherothrombosis in a large intracranial vessel. Balloon angioplasty should be the first choice and stenting should be performed later in refractory cases.

Effect of mechanical thrombectomy with vs. without intravenous thrombolysis in acute ischemic stroke.

Background: The results of mechanical thrombectomy (MT), wi-thout or with intravenous thrombolysis, were evaluated and compared in 178 patients with acute ischemic stroke (AIS) due to large vessel occlusions (LVO) at Bach Mai Hospital. Methods: A total of 178 patients with AIS due to LVO were assigned to undergo MT alone (MT-alone group) or MT preceded by intravenous alteplase (the combined group), at a dose of 0.9 mg per kilogram, administered within 4.5 hours after symptom onset (combined group). The successful recanalization rate (assessed as thrombolysis in cerebral infarction [TICI] classification of 2b-3) and the incidence of good clinical recovery outcomes (modified Rankin Scale [mRS] ≤2) after 3 months were analyzed in both groups and compared. Results: A total of 178 patients were enrolled (median age, 65 years; 55% men; median National Institutes of Health Stroke Scale [NIHSS]: 14.3). Favorable outcomes were reported in 76 patients (66.7%) in the MT-alone group and 42 patients (65.6%) in the com-bined group, with no significant between-group difference (P = 0.31 for noninferiority). However, MT alone was associated with a lower percentage of patients with successful reperfusion after MT compared with the combined group (87.7% vs. 90.6%). Mortality at 90 days was 12.2% (14 patients) in the MT-alone group and 17.2% (11 patients) in the combined group. The incidence of symptomatic intracerebral hemorrhage was not significantly different between groups (6 [5.3%] vs. 1 [1.6%]; P = 0.42). Conclusion: Among patients with AIS due to LVO in our study, MT alone was noninferior in terms of functional outcomes compared with MT preceded by the administration of intravenous alteplase within 4.5 hours after symptom onset.