Rescue intracranial stenting in acute ischemic stroke (study)

Abstract

Background and Purpose In cases of acute ischemic stroke that are caused by intracranial large vessel occlusion, rescue intracranial stenting has recently become a treatment option to achieve recanalization in patients when mechanical thrombectomy fails. However, there have been few studies to date that support this beneficial treatment. Our goal is to analyze whether the use of rescue intracranial stenting would improve “non-poor” prognosis in patients 3 months posttreatment. Methods This was a retrospective analysis of a prospective cohort of patients with acute ischemic stroke who were treated with rescue stenting at our hospital. Inclusion criteria for the study consisted of evidence of intracranial large vessel occlusion, absence of intracranial hemorrhage, and severe stenosis or reocclusion after mechanical thrombectomy. Tandem occlusions, failure to follow up after discharge, and a severe combined illness concomitant with acute ischemic stroke were excluded. The primary outcome was the “non-poor” outcome rate at 3 months and postprocedural symptomatic intracerebral hemorrhage. Results The posttreatment outcomes of 85 eligible patients who received rescue intracranial stenting between August 2019 and May 2021 are reported. In total, 82 of these patients (96.5%) had successful recanalization and 4 (4.7%) experienced symptomatic intracerebral hemorrhage. In total, 47 (55.3%) patients had “non-poor” and 35 (41.2%) good outcomes at 3 months after treatment with rescue intracranial stenting. The use of dual antiplatelet therapy was associated with new infarcts (relative risk = 0.1; 95% confidence interval 0.01–0.7) and symptomatic intracerebral hemorrhage (relative risk = 0.1; 95% confidence interval 0.01–0.9). Conclusion Our study suggests that despite the occurrence of postprocedural symptomatic intracerebral hemorrhage in a low proportion of cases, rescue intracranial stenting could be an important alternative treatment after mechanical thrombectomy failure.