Intracranial rescue stenting in the German stroke registry: a propensity score-matched multicenter study

BACKGROUND: Intracranial stenting (ICS) is used as a rescue strategy in patients with failed reperfusion after endovascular thrombectomy (EVT). However, real-world data on clinical outcomes and safety remain limited. METHODS: This retrospective analysis of prospectively collected data from the German Stroke Registry-Endovascular Treatment (GSR-ET) included patients with acute ischemic stroke due to middle cerebral artery (MCA) occlusion treated between June 2015 and December 2023. Patients undergoing ICS were compared with a 1:1 propensity score-matched cohort with failed reperfusion after EVT (final modified Thrombolysis in Cerebral Infarction [mTICI] score <2b) who received no further endovascular treatment. Functional, safety, and subgroup outcomes were assessed. RESULTS: Among the 14,714 eligible patients, ICS was performed in 352 (2.4%). After matching, 218 patients undergoing ICS were compared with 218 controls with failed reperfusion. ICS was associated with a shift toward better 90-day functional outcomes in unadjusted (cOR 0.52, 95% CI 0.37-0.73; p<0.01) and adjusted analyses (acOR 0.41, 95% CI 0.29-0.59; p<0.01). Malignant MCA infarction occurred less frequently in the ICS group (1% vs. 8%; p<0.01), as did 90-day mortality (26% vs. 37%; p=0.02). Symptomatic intracranial hemorrhage did not differ between groups (4% vs. 5%; p=0.63). CONCLUSIONS: Patients treated with ICS had a shift toward better functional outcomes and lower 90-day mortality than those with failed reperfusion who received no further endovascular treatment. Symptomatic intracranial hemorrhage did not differ between groups. These findings support further investigation of ICS after failed EVT, although randomized studies are needed to determine its efficacy and safety.