Comparative Safety and Efficacy of Balloon Mounted Stents and Self Expanding Stents in Rescue Stenting for Large Vessel Occlusion: Secondary analysis of the RESCUE-ICAS Registry

Sami Al Kasab; Adam T Mierzwa; Imad Samman Tahhan; Shadi Yaghi; Mouhammad Jumaa; Violiza Inoa; Francesco Capasso; Michael Nahhas; Robert M Starke; Isabel Fragata; Matthew T Bender; Krisztina Moldovan; Ilko Maier; Jonathan A Grossberg; Pascal Jabbour; Marios Psychogios; Edgar A Samaniego; Jan-Karl Burkhardt; David Altschul; Justin Mascitelli; Mohamad Ezzeldin; Ramesh Grandhi; Adam de Havenon; Thanh N Nguyen; Ameer E Hassan; RESCUE-ICAS Collaborators

doi:10.3174/ajnr.A8895

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Comparative Safety and Efficacy of Balloon Mounted Stents and Self Expanding Stents in Rescue Stenting for Large Vessel Occlusion: Secondary analysis of the RESCUE-ICAS Registry

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Comparative Safety and Efficacy of Balloon Mounted Stents and Self Expanding Stents in Rescue Stenting for Large Vessel Occlusion: Secondary analysis of the RESCUE-ICAS Registry

Sami Al Kasab, Adam T Mierzwa, Imad Samman Tahhan, Shadi Yaghi, Mouhammad Jumaa, Violiza Inoa, Francesco Capasso, Michael Nahhas, Robert M Starke, Isabel Fragata, …

American journal of neuroradiology : AJNR, Vol.46(12), pp.2514-2520

12/01/2025

DOI: 10.3174/ajnr.A8895

PMCID: PMC12687945

PMID: 40550702

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Abstract

Patients with intracranial stenosis-related large vessel occlusion (ICAS-LVO) may experience better outcomes with stenting compared to standalone mechanical thrombectomy. This study evaluates the safety and clinical outcomes of self-expanding stents (SES) versus balloon-mounted stents (BMS) in ICAS-LVO patients treated with mechanical thrombectomy and stenting. This secondary analysis of the RESCUE-ICAS registry, a multicenter observational study, included ICASLVO patients from 25 stroke centers who underwent stenting. Patients were stratified by stent type (SES or BMS). The primary endpoint was 90-day modified Rankin Scale (mRS) 0-2. Secondary outcomes included successful reperfusion, recurrent stroke, and infarct volume. Symptomatic intracranial hemorrhage was the primary safety outcome. Inverse probability weighting adjusted for confounders. Among 194 patients, 111 received SES, of whom 61 (55%) underwent pre-stenting angioplasty. After adjustment, no significant difference was observed between SES and BMS in 90-day mRS 0-2 (OR 1.10, 95% CI 0.62-1.96, p=0.75), successful reperfusion (mTICI ≥2B), or final infarct volume. SES was associated with higher odds of moderate stenosis (>50%) at follow-up (OR 3.7, 95% CI 1.15-11.98, p=0.02) and recurrent stroke (13.5% vs. 1.2%, p=0.001), particularly in patients without pre-stenting angioplasty (14% vs. 1%). SES and BMS demonstrated comparable safety and clinical outcomes in ICAS-LVO patients. However, SES was linked to higher rates of restenosis and recurrent strokes, potentially influenced by the absence of pre-stenting angioplasty. Further research is needed to refine stenting strategies in this population. BMS = balloon mounted stents, ICAS = intracranial atherosclerotic stenosis, IPW = Inverse probability weighted, MT = mechanical thrombectomy, LVO = Large vessel occlusion, RS = rescue stenting, RESCUE-ICAS = Registry of Emergent Large Vessel Occlusion due to Intracranial Stenosis, SES = self-expanding stents (SES).

Details

Title: Subtitle: Comparative Safety and Efficacy of Balloon Mounted Stents and Self Expanding Stents in Rescue Stenting for Large Vessel Occlusion: Secondary analysis of the RESCUE-ICAS Registry
Creators: Sami Al Kasab - Medical University of South Carolina
Adam T Mierzwa - University of Toledo
Imad Samman Tahhan - Medical University of South Carolina
Shadi Yaghi - Brown University
Mouhammad Jumaa - University of Toledo
Violiza Inoa - University of Tennessee Health Science Center
Francesco Capasso - Azienda Ospedaliero-Universitaria Careggi
Michael Nahhas - The University of Texas Health Science Center at Houston
Robert M Starke - University of Miami Health System
Isabel Fragata - Hospital de São José
Matthew T Bender - University of Rochester Medical Center
Krisztina Moldovan - Brown University
Ilko Maier - Universitätsmedizin Göttingen
Jonathan A Grossberg - Emory University
Pascal Jabbour - Thomas Jefferson University
Marios Psychogios - University Hospital of Basel
Edgar A Samaniego - University of Iowa Hospitals and Clinics
Jan-Karl Burkhardt - University of Pennsylvania
David Altschul - Montefiore Medical Center
Justin Mascitelli - The University of Texas Health Science Center at San Antonio
Mohamad Ezzeldin
Ramesh Grandhi - University of Utah
Adam de Havenon - Yale University
Thanh N Nguyen - Boston Medical Center
Ameer E Hassan - Valley Baptist Medical Center
RESCUE-ICAS Collaborators
Resource Type: Journal article
Publication Details: American journal of neuroradiology : AJNR, Vol.46(12), pp.2514-2520
DOI: 10.3174/ajnr.A8895
PMID: 40550702
PMCID: PMC12687945
NLM abbreviation: AJNR Am J Neuroradiol
ISSN: 1936-959X
eISSN: 1936-959X
Publisher: AMER SOC NEURORADIOLOGY; DENVILLE
Language: English
Electronic publication date: 06/27/2025
Date published: 12/01/2025
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984833486602771

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