Abstract
INTRODUCTION: Mechanical thrombectomy (MT) can be complicated by underlying intracranial atherosclerotic stenosis (ICAS), resulting in failed reperfusion or re‐occlusion requiring rescue adjunct stenting. This secondary analysis aims to describe the safety of rescue stenting in the MeVO population. METHODS: We conducted a secondary analysis of the RESCUE‐ICAS multicenter observational cohort study, focusing on patients with MeVO who underwent mechanical thrombectomy with or without adjunct emergent intracranial stenting. MeVO was defined as occlusion in the M2 or M3 segments of the middle cerebral artery, anterior cerebral artery, or posterior cerebral artery. The primary safety outcomes assessed were rates of symptomatic intracranial hemorrhage (sICH) and procedural complications. RESULTS: Of the 417 patients included in the primary study, 51 patients had medium vessel occlusion; 20 received adjunct stenting, and 31 underwent MT alone. Median age was 73 years and 24 (47.1%) were females. Median admission NIHSS was 13 and 17 (33.3%) received IV thrombolytics. General anesthesia was used in 31 (60.8%) and aspiration was used first in 25 (49%). In the overall MeVO cohort, 2 (3.9%) patients had symptomatic intracranial hemorrhage (1 patient in the stenting group and 1 in the MT alone group), and 2 (3.9%) patients had periprocedural complications (both in the MT alone group). CONCLUSION: This descriptive secondary analysis suggests that adjunct emergent stenting appears to be a safe intervention in MeVO patients with underlying ICAS, with low rates of symptomatic intracranial hemorrhage and procedural complications compared to MT alone. However, larger‐scale prospective studies are warranted to further validate the overall safety of this procedure in the MeVO population. Table 1. Demographics and outcomes in MeVO population [Image: see text]