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Updated: Dec 27, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Intracranial Stenting After Failed Thrombectomy in Patients With Moderately Severe Stroke: A Multicenter Cohort Study
Lukas Meyer1, Jens Fiehler1, Götz Thomalla2
1Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
Acute intracranial stenting (ICS) effectively improves recanalization in moderately severe stroke patients when thrombectomy fails. This bailout strategy is a viable option for improving outcomes after unsuccessful large vessel occlusion treatment.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Large vessel occlusions (LVO) refractory to thrombectomy require alternative treatments.
- Acute intracranial stenting (ICS) is emerging as a potential bailout strategy.
- Limited data exists on ICS feasibility and efficacy in moderately severe strokes (NIHSS ≤9).
Purpose of the Study:
- To evaluate the feasibility and effectiveness of acute intracranial stenting (ICS) in patients with moderately severe anterior circulation LVO after failed mechanical thrombectomy.
- To assess recanalization rates and neurological outcomes following ICS in this specific patient cohort.
Main Methods:
- Retrospective analysis of a multicenter database of patients undergoing ICS for anterior circulation LVO post-thrombectomy failure.
- Inclusion criteria: Moderately severe stroke (NIHSS ≤9), anterior circulation LVO, failed stent retriever mechanical thrombectomy (MT).
- Primary endpoint: Successful recanalization (modified Thrombolysis In Cerebral Infarction [mTICI] score ≥2b) post-ICS.
Main Results:
- Forty-one patients met inclusion criteria; a median of 2 MT attempts preceded ICS.
- ICS achieved successful recanalization (mTICI ≥2b) in 90.2% of cases.
- Early neurological improvement (ENI) was observed in 47.4%; symptomatic intracranial hemorrhage (sICH) occurred in 4.8%.
Conclusions:
- Acute intracranial stenting is an effective bailout strategy to improve recanalization in patients with moderately severe strokes following failed thrombectomy.
- ICS should be considered for patients with NIHSS ≤9 when mechanical thrombectomy is unsuccessful.
- This approach offers a viable option for improving outcomes in challenging LVO cases.
Abstract:
Background and Purpose: Recently, acute intracranial stenting (ICS) has gained more interest as a potential bailout strategy for large vessel occlusions (LVO) that are refractory to thrombectomy. However, there are currently no reports on ICS in patients with moderately severe stroke discussing the question if implementing a permanent stent is feasible and leads to improved recanalization after failed thrombectomy. Methods: We analyzed a large multicenter database of patients receiving ICS for anterior circulation LVO after failed thrombectomy. Inclusion criteria were defined as: Moderately severe stroke (National Institute Health Stroke Scale (NIHSS) ≤9 on admission), anterior circulation LVO, acute ICS after failed stent retriever MT. Primary endpoint was the rate of improved successful recanalization after ICS defined as a modified Thrombolysis In cerebral Infarction (mTICI) score≥2b. Favorable neurological outcome was defined as an early neurological improvement (ENI) of 4 points or reaching 0 with respect to baseline NIHSS. Results: Forty-one patients met the inclusion criteria. A median of 2 retrievals were performed (IQR 1-4) prior decision-making for ICS. ICS led in 90.2% (37/41) of cases to a final mTICI≥2b with significant improvement (p < 0.001) after the last retrieval attempt. The median NIHSS decreased (p = 0.178) from 7 (IQR 3.5-8) on admission to 2.5 (IQR 0-8.25) at discharge. ENI was observed in 47.4% (18/38). sICH occurred in 4.8% (2/41). Conclusion: ICS after failed thrombectomy appears to effectively improve recanalization rates in patients with moderately severe strokes. Thus, ICS should be considered also for patients with baseline NIHSS ≤9 if thrombectomy fails.
