PURPOSE Mechanical thrombectomy (MT) failure is associated with very poor prognosis. Permanent intracranial stenting (PIS) may be useful in such refractory occlusions. However, this strategy requires an aggressive antithrombotic regimen that may be harmful in extended strokes. The aim of this study was to compare clinical outcomes between patients with refractory acute large vessel occlusions (LVOs) treated by PIS versus patients for whom the procedure was stopped without recanalization. METHODS We conducted a systematic review by searching for articles in PubMed, the Cochrane Library, and ClinicalTrials.gov from January 2015 to September 2019. Two reviewers independently selected studies comparing PIS after failed MT in addition to usual care versus usual care only. A comparative meta-analysis was performed using random-effects models to estimate odds ratios of favorable clinical outcome at 90 days, defined as a modified Rankin scale 0-2, mortality and symptomatic intracranial hemorrhage (SICH). RESULTS Four comparative studies were included for a total of 352 patients: 149 in the PIS group versus 203 in the control group. PIS was associated with significantly higher rates of 90-day favorable clinical outcome (odds ratio [OR], 2.87 [95% confidence interval (95% CI), 1.77-4.66]; p < 0.001; I2, 0%) and lower mortality (OR, 0.39 [0.16-0.93]; p = 0.03; I2, 43%), whereas SICH rates did not significantly differ (OR, 0.68 [0.37-1.27]; p = 0.23; I2, 0%). CONCLUSION From observational study results, attempting PIS after failed MT seems to improve clinical outcomes without increasing the risk of intracranial bleeding. Randomized trials are needed to confirm these results.

中文翻译：

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难治性大血管阻塞中的抢救性支架置放与单独医疗护理：系统评价和荟萃分析。

目的机械性血栓切除术（MT）失败与预后不良有关。永久性颅内支架置入术（PIS）在此类难治性阻塞中可能有用。但是，此策略需要积极的抗血栓治疗方案，这对延长卒中可能有害。这项研究的目的是比较接受PIS治疗的难治性急性大血管阻塞（LVO）患者与未经再次通气而停止手术的患者之间的临床结局。方法我们通过检索2015年1月至2019年9月在PubMed，Cochrane图书馆和ClinicalTrials.gov中的文章进行了系统的评价。两名评价者独立选择了MT失败后的PIS，除了常规治疗还是常规治疗。使用随机效应模型进行比较性荟萃分析，以评估90天临床疗效良好的优势比，定义为改良的Rankin量表0-2，死亡率和有症状的颅内出血（SICH）。结果共纳入四项比较研究，共352例患者：PIS组149例，对照组203例。PIS与90天的良好临床结局发生率显着升高相关（赔率[OR]为2.87 [95％置信区间（95％CI）为1.77-4.66]； p <0.001； I2为0％）和较低的死亡率（OR，0.39 [0.16-0.93]； p = 0.03； I2，43％），而SICH率无显着差异（OR，0.68 [0.37-1.27]； p = 0.23； I2，0％）。结论从观察性研究结果来看，MT失败后尝试PIS似乎可以改善临床结果，而不会增加颅内出血的风险。需要随机试验来确认这些结果。