Rescue Intracranial Stenting Improves Outcomes After Mechanical Thrombectomy for Basilar Artery Occl

Introduction Basilar artery occlusion carries high morbidity and mortality, especially when mechanical thrombectomy (MT) fails. Patients with unsuccessful MT persistent occlusion and limited collateral circulation contribute to poor outcomes. Rescue intracranial stenting has been proposed to restore reperfusion, but evidence on its efficacy and safety compared with the natural course of failed MT remains scarce. This meta‐analysis evaluates the impact of rescue stenting on functional outcomes, defined by the modified Rankin Scale (mRS 0‐3), in patients with failed MT for basilar artery occlusion. Methods A meta‐analysis was developed using PubMed, Scopus, and Cochrane databases. We included adult patients with basilar artery occlusion and failed MT (mTICI 0‐2a after ≥1 attempt) treated with rescue stenting. Comparators included natural history. Outcomes analyzed were: (1) mRS 0‐2 at 90 days, (2) mRS 0‐3 at 90 days, (3) 90‐day mortality, and (4) symptomatic intracranial hemorrhage (sICH). Results Of 2,943 records screened, five studies met inclusion criteria, comprising 1135 patients: 768 (67,66%) underwent rescue stenting and 367 (32,33%) as controls. Rescue stenting showed a trend toward significant better functional outcomes (mRS 0‐3 RR 2.07, 95% CI 1.20‐3.58; p=0.009); although mRS 0‐2 (RR 1.85, 95% CI 0.98‐3.48; p=0.06) did not show statistically significant difference. 90 day mortality was significantly lower (RR 0.63, 95% CI 0.43‐0.91; p=0.02). However, the incidence of sICH was not different in the stenting group (RR 0.51, 95% CI 0.15‐1.71; p=0.27). Conclusion Rescue intracranial stenting after failed MT in basilar artery occlusion was associated with a significant improvement in functional outcomes (mRS 0‐3) and a significant reduction in 90 day mortality. These suggest a potential advantage in current treatment options in patients with failed MT, however further high‐quality studies are needed to establish its impact on survival and long term recovery.