Abstract 153: When Thrombectomy Fails: Rescue Stenting Improves Outcomes — A Meta‐analysis With Institutional Case Experience

Background Mechanical thrombectomy (MT) has become the standard treatment for patients with acute ischemic stroke due to large vessel occlusion (LVO). Nevertheless, a significant proportion (10‐29%) of patients fail to achieve successful reperfusion, resulting in poor outcomes. Rescue therapies (RT) are therefore critical for patients experiencing reperfusion failure. Among the various RT options, rescue stenting has shown promise, particularly in patients with intracranial atherosclerotic disease (ICAS), where underlying fixed stenosis often complicates MT efforts. However, the potential benefits of rescue stenting must be evaluated against the risks, including hemorrhagic complications arising from aggressive antithrombotic therapies. This meta‐analysis aims to assess the efficacy and safety of rescue stenting in patients with acute ischemic stroke following failed MT. Methods We conducted a systematic review and meta‐analysis following PRISMA guidelines. Comprehensive literature searches were performed across Ovid Medline, Embase, and Cochrane CENTRAL through 2024. Studies comparing rescue stenting to non‐stenting after failed MT were included. The primary outcome was a favorable functional outcome (modified Rankin Scale mRS 0‐2); secondary outcomes included recanalization rates, symptomatic intracranial hemorrhage (sICH), and 90‐day mortality. Results Eighteen studies involving 3,871 participants were included. Rescue stenting was associated with significantly higher odds of achieving favorable functional outcomes (mRS 0‐2) compared to non‐stenting approaches (OR 2.55, 95% CI 1.85‐3.52, p<0.001; I 2 =59%). Rescue stenting showed a trend toward reduced 90‐day mortality (OR 0.60, 95% CI 0.35‐1.04, p=0.07; I 2 =84%) without significantly increasing sICH risk (OR 0.84, 95% CI 0.62‐1.15, p=0.28; I 2 =17%). The pooled recanalization rate with rescue stenting was substantially higher than that of non‐stenting approaches (OR 40.45, 95% CI 9.23‐177.20, p<0.001; I 2 =89%). Conclusion Rescue stenting following failed mechanical thrombectomy significantly improves functional outcomes and recanalization rates without substantially increasing hemorrhagic complications. These findings support rescue stenting as an effective strategy for refractory large vessel occlusions, particularly in ICAS‐related strokes. Future research should focus on refining patient selection criteria, standardizing technical approaches, and optimizing post‐procedure antithrombotic management. Keywords : Rescue stenting, acute ischemic stroke, mechanical thrombectomy, large vessel occlusion, recanalization, mortality.