Rescue stenting after failed mechanical thrombectomy: The RES-CAT study

Area of Science:

• Neurology
• Interventional Neuroradiology
• Stroke Medicine

Background:

• Mechanical thrombectomy (MT) is a primary treatment for large-vessel occlusion (LVO) stroke.
• The role of intracranial rescue stenting (RS) after failed MT remains unclear.
• Evaluating RS efficacy in anterior circulation LVO stroke is crucial.

Purpose of the Study:

• To assess the clinical outcomes of rescue stenting (RS) in patients with anterior circulation LVO stroke following unsuccessful mechanical thrombectomy (MT).
• To compare functional status, complication rates, and mortality between patients who received RS and those who did not.

Main Methods:

• Retrospective analysis of a prospective, population-based registry (Stroke Code Registry of Catalonia, 2016-2022).
• Included 601 patients with anterior circulation LVO stroke; 69 underwent RS after failed MT.
• Used inverse probability of treatment weighting (IPTW) to adjust for confounders and analyzed 90-day functional outcomes (modified Rankin Scale), complications, and mortality.

Main Results:

• Rescue stenting (RS) did not significantly alter the overall 90-day functional status shift (acOR 1.06).
• However, RS was associated with significantly higher rates of good (18.8% vs 11.7%) and excellent (17.4% vs 5.7%) functional outcomes.
• No significant differences were observed in symptomatic intracranial hemorrhage, 90-day mortality, or stroke recurrence between groups.

Conclusions:

• Rescue stenting (RS) may enhance good and excellent functional outcomes in anterior LVO stroke patients with failed MT.
• RS appears safe, not increasing long-term risks such as hemorrhage, mortality, or recurrence.
• Further randomized controlled trials are needed to validate these findings.