Comparison of early versus late rescue stenting after failed thrombectomy for intracranial atherosclerosis-related large vessel occlusion.

Abstract

The optimal timing for rescue stenting (RS) following failed thrombectomy in patients with underlying intracranial atherosclerosis (ICAS)-related large vessel occlusion (LVO) remains unknown. We aimed to determine this by comparing the angiographic and clinical outcomes of early and late RS. We retrospectively enrolled patients with acute ischemic stroke who underwent stent-retriever thrombectomy for ICAS-related LVO. Per-pass analysis was performed to assess recanalization rates after each retrieval in all patients. Patients were classified into early and late groups based on the number of stent retrievals before RS (early: 1 or 2 attempts; late: ≥ 3 attempts). Angiographic and clinical outcomes were compared between these two groups. Among 126 patients with ICAS-related LVO, 257 retrievals were evaluated. Successful and complete recanalization rates were highest on the first attempt and significantly decreased between the second and third passes. Overall, 56 patients underwent RS, of which 27 and 29 were classified into the early and late RS groups, respectively. The early RS group had shorter procedure times (45 min vs. 70 min, p < 0.001) and higher rates of favorable outcomes (85.2% vs. 55.2%, p = 0.014) than the late RS group. Intact stent patency rates were also higher in the early RS group than in the late RS group (88.0% vs. 65.4%, p = 0.059). Multivariate analysis identified early RS (OR, 7.187; 95% CI, 1.385-37.306; p = 0.019) and stent patency (OR, 7.291; 95% CI, 1.288-41.277; p = 0.025) as significant factors influencing favorable outcomes. RS should be performed at an early stage after failed thrombectomy for ICAS-related LVO.