PT  - JOURNAL ARTICLE
AU  - Al Kasab, Sami
AU  - Mierzwa, Adam T
AU  - Tahhan, Imad Samman
AU  - Yaghi, Shadi
AU  - Jumaa, Mouhammad
AU  - Inoa, Violiza
AU  - Capasso, Francesco
AU  - Nahhas, Michael
AU  - Starke, Robert M.
AU  - Fragata, Isabel
AU  - Bender, Matthew T.
AU  - Moldovan, Krisztina
AU  - Maier, Ilko
AU  - Grossberg, Jonathan A.
AU  - Jabbour, Pascal
AU  - Psychogios, Marios
AU  - Samaniego, Edgar A
AU  - Burkhardt, Jan-Karl
AU  - Altschul, David
AU  - Mascitelli, Justin
AU  - Ezzeldin, Mohamad
AU  - Grandhi, Ramesh
AU  - de Havenon, Adam
AU  - Nguyen, Thanh N.
AU  - Hassan, Ameer E.
AU - RESCUE-ICAS Collaborators
TI  - Comparative Safety and Efficacy of Balloon Mounted Stents and Self Expanding Stents in Rescue Stenting for Large Vessel Occlusion: Secondary analysis of the RESCUE-ICAS Registry
AID  - 10.3174/ajnr.A8895
DP  - 2025 Jun 23
TA  - American Journal of Neuroradiology
PG  - ajnr.A8895
4099  - http://www.ajnr.org/content/early/2025/06/23/ajnr.A8895.short
4100  - http://www.ajnr.org/content/early/2025/06/23/ajnr.A8895.full
AB  - BACKGROUND AND PURPOSE: Patients with intracranial stenosis-related large vessel occlusion (ICAS-LVO) may experience better outcomes with stenting compared to standalone mechanical thrombectomy. This study evaluates the safety and clinical outcomes of self-expanding stents (SES) versus balloon-mounted stents (BMS) in ICAS-LVO patients treated with mechanical thrombectomy and stenting.MATERIALS AND METHODS: This secondary analysis of the RESCUE-ICAS registry, a multicenter observational study, included ICASLVO patients from 25 stroke centers who underwent stenting. Patients were stratified by stent type (SES or BMS). The primary endpoint was 90-day modified Rankin Scale (mRS) 0–2. Secondary outcomes included successful reperfusion, recurrent stroke, and infarct volume. Symptomatic intracranial hemorrhage was the primary safety outcome. Inverse probability weighting adjusted for confounders.RESULTS: Among 194 patients, 111 received SES, of whom 61 (55%) underwent pre-stenting angioplasty. After adjustment, no significant difference was observed between SES and BMS in 90-day mRS 0–2 (OR 1.10, 95% CI 0.62–1.96, p=0.75), successful reperfusion (mTICI ≥2B), or final infarct volume. SES was associated with higher odds of moderate stenosis (>50%) at follow-up (OR 3.7, 95% CI 1.15–11.98, p=0.02) and recurrent stroke (13.5% vs. 1.2%, p=0.001), particularly in patients without pre-stenting angioplasty (14% vs. 1%).CONCLUSIONS: SES and BMS demonstrated comparable safety and clinical outcomes in ICAS-LVO patients. However, SES was linked to higher rates of restenosis and recurrent strokes, potentially influenced by the absence of pre-stenting angioplasty. Further research is needed to refine stenting strategies in this population.ABBREVIATIONS: BMS = balloon mounted stents, ICAS = intracranial atherosclerotic stenosis, IPW = Inverse probability weighted, MT = mechanical thrombectomy, LVO = Large vessel occlusion, RS = rescue stenting, RESCUE-ICAS = Registry of Emergent Large Vessel Occlusion due to Intracranial Stenosis, SES = self-expanding stents (SES)