RT Journal Article
SR Electronic
T1 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
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP ajnr.A8895
DO 10.3174/ajnr.A8895
A1 Al Kasab, Sami
A1 Mierzwa, Adam T
A1 Tahhan, Imad Samman
A1 Yaghi, Shadi
A1 Jumaa, Mouhammad
A1 Inoa, Violiza
A1 Capasso, Francesco
A1 Nahhas, Michael
A1 Starke, Robert M.
A1 Fragata, Isabel
A1 Bender, Matthew T.
A1 Moldovan, Krisztina
A1 Maier, Ilko
A1 Grossberg, Jonathan A.
A1 Jabbour, Pascal
A1 Psychogios, Marios
A1 Samaniego, Edgar A
A1 Burkhardt, Jan-Karl
A1 Altschul, David
A1 Mascitelli, Justin
A1 Ezzeldin, Mohamad
A1 Grandhi, Ramesh
A1 de Havenon, Adam
A1 Nguyen, Thanh N.
A1 Hassan, Ameer E.
A1 RESCUE-ICAS Collaborators
YR 2025
UL http://www.ajnr.org/content/early/2025/06/26/ajnr.A8895.abstract
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)