RESCUE-ICAS: Rationale and Study Design

Mechanical thrombectomy (MT) failure occurs in ≈10% to 20% of MTs. Among the common causes of failed MT is residual underlying intracranial stenosis (ICAS), typically attributable to atherosclerotic disease. ICAS large-vessel occlusion (ICAS-LVO) remains poorly understood, and management of ICAS-LVO is unclear. The RESCUE-ICAS (Registry of Emergent Large Vessel Occlusion Due to Intracranial Stenosis) aims at providing better understanding of the prevalence of ICAS-LVO, and the overall safety and efficacy of various rescue therapies.

RESCUE-ICAS is a multicenter, international, prospective registry that is currently enrolling patients with ICAS-LVO who underwent MT. All sites are required to report monthly MT cases that meet inclusion criteria. The decision of whether to use rescue therapy is up to the interventionist.

We will collect patients' demographic, clinical, and radiographic data at baseline. Also, we will capture variables related to the MT procedure and rescue therapy (if performed), and postprocedural clinical and imaging variables. Outcomes include the rate of successful recanalization, defined by modified Thrombolysis in Cerebral Infarction score of ≥2b, the rate of symptomatic intracranial hemorrhage, the 90-day modified Rankin scale score, and mortality.

No strong evidence is currently available to support an optimal treatment strategy for patients with ICAS-LVO undergoing MT. RESCUE-ICAS is a prospective cohort study that will provide important data to help design randomized controlled trials.