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Abstract 050: Rescue Stenting for Failed Mechanical Thrombectomy in Acute Basilar Artery Occlusions: Analysis of the PC‐SEARCH Thrombectomy Registry
Abstract   Open access   Peer reviewed

Abstract 050: Rescue Stenting for Failed Mechanical Thrombectomy in Acute Basilar Artery Occlusions: Analysis of the PC‐SEARCH Thrombectomy Registry

A Rodriguez-Calienes, S Ortega-Gutierrez, A Mierzwa, M Galecio-Castillo, M Dibas, S Al Kasab, A Nelson, A Jadhav, S Desai, G Toth, …
Stroke: vascular and interventional neurology, Vol.4(S1)
11/01/2024
DOI: 10.1161/SVIN.04.suppl_1.050
PMCID: PMC12773872
url
https://doi.org/10.1161/SVIN.04.suppl_1.050View
Published (Version of record) Open Access

Abstract

IntroductionWe aimed to investigate whether rescue stenting (RS) following failed mechanical thrombectomy (MT) for acute basilar artery occlusion (BAO) results in superior functional outcomes and enhanced safety compared to the natural history of failed mechanical thrombectomy (MT).MethodsThis retrospective cohort observational study utilized data from the PC‐SEARCH registry, encompassing eight high‐volume centers in the United States and covering the period from 2015 to 2021. Patients with BAO who experienced failed MT (mTICI score of 0‐2a after at least one attempt of clot retrieval) were categorized based on whether they received additional intervention with RS. The primary outcome was a shift analysis of the 90‐day mRS. Multivariable logistic regression was employed to assess both efficacy and safety outcomes. We conducted further analysis to assess the heterogeneity in the treatment effects of RS. Additionally, a comparative analysis employing propensity‐score matching (PSM) with a 2:1 matching was conducted to compare successful reperfusion with MT against RS with successful reperfusion.ResultsAmong 444 patients, 119 experienced failed MT and were included in the analysis. The RS group comprised 65 patients (14.6%), while the control group included 54 patients (12.2%). After adjustments, the RS group demonstrated a favorable shift in the overall 90‐day mRS distribution (acOR=4.56; 95%CI 1.67‐12.45; p=0.003). Additionally, the RS group had higher rates of 90‐day mRS of 0‐3 (RS: 44.6% vs. control: 18.5%, aOR=7.57; 95%CI 1.91‐30.12; p=0.004) compared to the control group. Mortality at 90 days was also significantly lower in the RS group (RS: 43.1% vs. control: 64.8%, aOR=0.27; 95%CI 0.09‐0.80; p=0.018), with similar rates of sICH (RS: 3.1% vs. control: 13%, aOR=0.31; 95%CI 0.05‐1.95; p=0.214). The association between RS and reduced disability remained consistent across different stroke etiologies but was more pronounced in patients under 70 years of age (acOR=2.88; 95% CI 1.16‐7.17; p=0.023), those with a PC‐ASPECTS of ≥8 (acOR=3.76; 95%CI 1.58‐8.96; p=0.003), and those treated within an early time window (acOR=8.18; 95%CI 1.92‐34.84; p=0.004). Using PSM, there was no significant difference in 90‐day mRS scores between patients who had successful MT (median mRS: 4 [IQR 2‐6]) and those who had RS with successful reperfusion (median mRS: 3 [IQR 2‐6], OR=1.03; 95%CI 0.53‐2.00; p=0.915).ConclusionOur study demonstrated that RS is associated with improved functional outcomes and reduced mortality in BAO patients presenting MT failure. Further randomized trials are needed to validate these findings.

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