1249 Single-Center Outcomes of Onyx Frontier and Resolute Onyx Drug-Eluting Balloon Mounted Stents for Rescue Stenting for Acute Large Vessel Occlusion

Abstract

INTRODUCTION: Mechanical thrombectomy (MT) is a common treatment for large vessel occlusions with recent literature expanding its indications. In cases where MT fails, rescue stenting may be necessary to achieve reperfusion; however, the absence of standardized techniques or devices poses a challenge. METHODS: A retrospective chart review was performed of all patients who underwent rescue stenting, in the setting of MT, using Onyx Frontier or Resolute Onyx stents at a single institution. Technical details, procedural complications, and patient outcomes were recorded for each case. RESULTS: In total, 21 Onyx Frontier and Resolute Onyx stents were deployed in 18 patients undergoing rescue stenting. Among these, 13 involved the use of Resolute Onyx stents, while 5 cases utilized Onyx Frontier stents. Stent locations included the middle cerebral artery (40%), internal carotid artery (15%), vertebral artery (20%), and basilar artery (25%). The average NIHSS score before MT was 13.83 (range 0-31). The median initial mRS score was 0, while the median mRS score at follow-up was 3. Successful reperfusion, as assessed by TICI scores, was achieved in 43.8% of patients for TICI 3, 43.8% for TICI 2C, and 12.5% for TICI 2B. The average proximal vessel diameter was 2.31 mm, and the most used stent length was 12 mm. Post-revascularization, 33% of patients experienced hemorrhage, of which only one patient (16.7%) had symptomatic hemorrhage due to vessel rupture necessitating hemicraniectomy. CONCLUSIONS: Onyx Frontier and Resolute Onyx stents are well-suited for rescue stenting in cases where aspiration and stentriever techniques fail during MT. These balloon-mounted drug-eluting stents exhibit excellent navigability, rendering them appropriate for rescue revascularization procedures. Our findings demonstrate that these stents confer a high degree of technical success and a low rate of intra- and post-procedural complications.