Rescue stenting after failed mechanical thrombectomy: The RES-CAT study.

Abstract

Introduction: The efficacy of intracranial rescue stenting (RS) following failed mechanical thrombectomy (MT) in large-vessel occlusion (LVO) stroke remains uncertain. We aimed to evaluate clinical outcomes of RS in patients with anterior circulation LVO stroke following unsuccessful MT.

Patients and methods: We conducted a retrospective analysis using the Stroke Code Registry of Catalonia (January 2016-March 2022), a prospective, population-based registry including patients treated at 10 comprehensive stroke centers. We compared outcomes between patients who received RS and those who did not after failed MT. The primary outcome was the shift in 90-day functional status, assessed by the modified Rankin Scale (mRS), adjusted for confounders using inverse probability of treatment weighting (IPTW). Secondary outcomes included good (mRS ⩽ 2 or 3 if baseline mRS was 3) and excellent (mRS ⩽ 1) outcomes, ischemic recurrences, hemorrhagic transformation, and 90-day mortality.

Results: Of 601 patients, 69 underwent RS. RS did not significantly impact the 90-day mRS shift (adjusted common odds ratio [acOR] 1.06, [95% CI 0.85-1.32]; p = 0.613). However, RS was associated with higher rates of good (18.8% vs 11.7%; aOR 1.41, [95% CI 1.00-1.99]; p = 0.048) and excellent outcomes (17.4% vs 5.7%; aOR 2.90, [95% CI 1.89-4.43]; p < 0.001). Symptomatic intracranial hemorrhage (9.4% vs 7.4%; p = 0.507) and 90-day mortality (30.4% vs 39.8%; p = 0.135) were similar between groups. Stroke recurrence (4.2% vs 1.7%; p = 0.247) showed no significant difference at 33-month follow-up.

Discussion and conclusion: RS may increase the likelihood of good and excellent outcomes in anterior LVO stroke after failed MT, without increasing long-term risks. Further randomized trials are warranted for comprehensive validation.