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Effect of Acute Intracranial Stenting in Patients With Successful Reperfusion Following Large-Vessel Occlusion Secondary to Intracranial Atherosclerosis: Secondary Analyses of the RESCUE-ICAS Study
Journal article   Open access   Peer reviewed

Effect of Acute Intracranial Stenting in Patients With Successful Reperfusion Following Large-Vessel Occlusion Secondary to Intracranial Atherosclerosis: Secondary Analyses of the RESCUE-ICAS Study

Sarah Nguyen, Adam de Havenon, Eyad Almallouhi, Mohammad A. Jumaa, Violiza Inoa, Francesco Capasso, Michael I. Nahhas, Robert M. Starke, Isabel Fragata, Matthew T. Bender, …
Stroke: vascular and interventional neurology, Vol.6(2), e001841
03/2026
DOI: 10.1161/SVIN.125.001841
PMCID: PMC12959446
PMID: 41815302
url
https://doi.org/10.1161/SVIN.125.001841View
Published (Version of record) Open Access

Abstract

BACKGROUND: The RESCUE-ICAS study (Registry of Emergent Large-Vessel Occlusion due to Intracranial Stenosis) demonstrated that patients undergoing acute stenting of intracranial atherosclerosis with large-vessel occlusion after mechanical thrombectomy had better outcomes than those undergoing mechanical thrombectomy alone. We present 2 secondary analyses of RESCUE-ICAS to evaluate intracranial stenting among patients who achieved successful reperfusion. METHODS: From a prospective observational cohort of 25 stroke centers (2022–2023), patients with acute intracranial occlusion, National Institutes of Health Stroke Scale score ≥6, and 50% to 99% residual stenosis or occlusion after endovascular thrombectomy were included. In the first analysis, we compared patients with stenting versus those without stenting from among those patients with a final modified Thrombolysis in Cerebral Infarction score of 2B–3. In the second analysis, we compared patients who underwent stenting with those who did not from among the patients with a Thrombolysis in Cerebral Infarction (TICI) score of 2B–3 before stenting. The odds of a favorable 90-day mRS (0–2) and 24-hour MRI infarct volume <30 mL were assessed using multivariable logistic regression. We also examined the rates of symptomatic ICH and death at 90 days in these cohorts. RESULTS: Overall, 351 (84.2%) patients had successful reperfusion, with 181 (51.7%) undergoing stenting. More patients who underwent acute stenting achieved an mRS score of 0 to 2 at 90 days (adjusted odds ratio, 1.88; P=0.024). Patients who underwent stent placement were more likely to have 24-hour MRI infarct volume <30 mL (70.1% versus 54.8%, P=0.022). Our second analysis demonstrated that 89 patients who underwent acute intracranial stenting after successful perfusion (postmechanical thrombectomy) experienced higher odds of mRS scores of 0 to 2 at 90 days (adjusted odds ratio, 2.19 [95% CI, 1.01–4.74]) and 24-hour MRI infarct volume <30 mL (adjusted odds ratio, 3.27 [95% CI, 1.05–10.19]) than the 170 without stenting after successful reperfusion. There was no significant difference in rates of symptomatic ICH (7.2% versus 5.3%; P=0.466) or death at 90 days (22.7% versus 25.9%; P=0.480). CONCLUSIONS: Among both the cohort with final successful reperfusion and the cohort with initial successful reperfusion after mechanical thrombectomy alone, intracranial stenting was associated with better long-term clinical and radiographic outcomes, without higher morbidity and mortality.
 Angioplasty Magnetic Resonance Imaging ischemic stroke reperfusion thrombectomy

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