Introduction Among patients with emergent large vessel occlusion due to intracranial stenosis (ICAS‐LVO), the effect of reperfusion status following thrombectomy remains unknown. In this secondary analysis of the RESCUE‐ICAS registry, we evaluated the impact of baseline reperfusion status on outcomes of mechanical thrombectomy with and without bailout stenting. Methods We conducted a secondary analysis of the RESCUE‐ICAS registry which included patients who underwent thrombectomy with or without bailout stenting for acute ICAS‐LVO. Patients were classified into four groups based on baseline reperfusion status and stenting use. Successful recanalization was defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2B. The primary outcome was 90‐day functional independence (mRS 0‐2). Associations were analyzed using multivariable logistic regression with inverse probability of treatment weighting (IPTW). Results A total of 413 patients were analyzed across four groups: MT alone with failed recanalization (n=55), MT alone with successful recanalization (n=184), MT with stent after failed pre‐stent recanalization (n=108), and MT with stent after successful pre‐stent recanalization (n=66). Baseline characteristics were similar, except for age (p=0.004) and hyperlipidemia (p=0.003). On multivariable analysis, there was no difference in 90‐day outcome between patients with MT + bailout stenting with and without successful pre‐stent reperfusion. However, MT + bailout stenting with successful pre‐stenting reperfusion was associated with better 90‐day outcome compared to MT alone with successful reperfusion. Conclusion Adjunct stenting was associated with improved 90‐day functional outcomes in ICAS‐LVO patients even in patients with successful pre‐stenting reperfusion. These findings support early consideration of stenting in ICAS‐LVO to reduce re‐occlusion risk and improve long‐term outcomes. image
Havenon et al. (Sat,) studied this question.