Objective To assess the efficacy and safety of rescue stenting and angioplasty following endovascular thrombectomy (EVT) in patients with acute ischemic stroke due to intracranial atherosclerotic large vessel occlusion (ICAD‐LVO). Background Rescue therapies are increasingly used after EVT failure in ICAD‐LVO, but their clinical benefit and safety profile remain uncertain. Methods We conducted a systematic review and meta‐analysis of comparative studies involving adult ICAD‐LVO patients treated with EVT with or without rescue therapy (RT). The primary outcome was functional independence at 90 days (mRS 0‐2). Secondary outcomes included successful recanalization (TICI ≥2b), symptomatic intracranial hemorrhage (sICH), mortality, and procedural complications. Subgroup analyses were performed based on glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitor use. Results Nine studies (n = 2,040) were included. RT significantly improved successful recanalization (OR: 2.00; 95% CI: 1.46‐2.74; p < 0.01), but did not significantly improve functional independence (OR: 1.31; 95% CI: 0.94‐1.82; p = 0.11). RT was associated with increased sICH (OR: 1.54; 95% CI: 1.06‐2.23; p = 0.023), arterial perforation, and dissection, but not with increased mortality. Subgroup analysis showed that RT improved outcomes in studies with limited GPIIb/IIIa use (OR: 1.55; 95% CI: 1.04‐2.31; p = 0.0467), but not in studies where GPIIb/IIIa inhibitors were uniformly administered across both EVT alone and EVT+RT groups (OR: 1.04; 95% CI: 0.64‐1.67; p = 0.0734). Conclusion Rescue stenting and angioplasty improve angiographic outcomes in ICAD‐LVO but are linked to higher procedural risks without consistent functional benefit. Their efficacy may be influenced by adjunctive pharmacologic strategies. Further trials are needed to refine patient selection and optimize treatment protocols. image image
Aljbour et al. (Sat,) studied this question.