Periprocedural determinants and clinical impact of stent patency after rescue stenting for intracranial atherosclerosis related emergent large vessel occlusion.

Abstract

Rescue stenting (RS) is frequently performed in patients with intracranial atherosclerosis related emergent large vessel occlusion (ICAS-ELVO) when mechanical thrombectomy fails to achieve durable reperfusion. Although RS can restore antegrade flow, subsequent loss of stent patency may adversely affect neurological recovery. However, evidence regarding factors influencing stent patency after RS and its clinical relevance is limited. We retrospectively analyzed patients with anterior circulation ICAS-ELVO who underwent RS during endovascular treatment. Stent patency was assessed on follow-up vascular imaging obtained within 7 days after the procedure and categorized as preserved or impaired. Baseline characteristics, procedural details, angiographic findings, and periprocedural antithrombotic management were analyzed. Multivariable logistic regression analyses were performed to identify independent determinants of stent patency and favorable functional outcome. Among 86 patients undergoing RS, impaired stent patency was observed in 18 patients (20.9%). A higher number of stent retrievals before stent deployment was independently associated with impaired stent patency, whereas postprocedural intravenous tirofiban infusion (n=40) was associated with preserved stent patency. Preserved stent patency was independently associated with a higher likelihood of favorable functional outcomes. Patients with impaired stent patency had worse functional outcomes and showed a trend toward higher rates of early neurological deterioration. In patients with ICAS-ELVO treated with RS, stent patency was closely related to periprocedural factors, including the number of stent retrieval attempts before stent deployment and postprocedural intravenous tirofiban infusion. Preservation of stent patency was associated with improved neurological outcomes, highlighting the potential value of optimizing stent deployment timing and postprocedural antithrombotic management to achieve durable clinical benefit after RS.