Abstract Number ‐ 154: Outcomes of Rescue Intracranial Stenting vs Failed Recanalization during Mechanical Thrombectomy

Abstract

Introduction Rescue stenting may be considered during mechanical thrombectomy (MT) if a newly recanalized intracranial vessel keeps re‐occluding, or recanalization is not achieved with conventional thrombectomy methods. There are multiple published case series with mixed results on safety and efficacy of this approach, and there are no available randomized trials. We aimed to compare the outcomes of rescue intracranial stenting with unsuccessful/poor reperfusion after MT. Methods Retrospective review of ischemic stroke patients who underwent MT from 2016–2021. Emergent intracranial stent patients were selected and compared with those who had poor/unsuccessful post‐procedural reperfusion (TICI 0–2a). Initial ASPECT score, NIHSS, number of passes, and MT method (aspiration vs stentriever) were recorded. Complications (intracranial hemorrhage, vessel perforation, groin or retroperitoneal hematoma, or distal embolization), final infarct size, 90‐day mRS, and mortality were analyzed. Results Sixteen patients underwent emergent intracranial stenting. Of the 89patients with failed MT, 34 had TICI 2a, 11 had TICI 1, and 44 had TICI 0 reperfusion. All 16 stenting patients achieved TICI 2B‐3 grade recanalization. Pre‐procedure ASPECT score was similar between both groups. Six patients had either intracranial vertebral or basilar artery stenting, and 10 had either intracranial ICA or MCA stenting. Patients with posterior compared to anterior circulation involvement were more likely to receive stenting (50% vs 11%, p = 0.003). There were no differences in the stenting versus non‐stenting group in 24‐hour post intervention NIHSS, post‐procedural complications, intracranial hemorrhage, infarct size, and mortality (75% vs 67%). The stenting group had better functional independence (mRS 0–2) at 90 days (33% vs 11%, p = 0.04). There were no outcome differences in anterior compared to posterior circulation stenting. Conclusions Rescue stenting was more often seen with posterior circulation strokes. In patients with failed or unsuccessful reperfusion after conventional MT, emergent stenting achieved better 90‐day functional independence without increasing rates of complications, intracranial hemorrhage, or mortality.