Long-Term Outcome of Rescue Stenting for Acute Intracranial Atherosclerotic Stenosis Related Large Vessel Occlusion in Anterior Circulation

Hyungjong Park; Byung Moon Kim; Jun-Whee Kim; Jin Woo Kim; Jang-Hyun Baek; Dong Joon Kim; Min Jeoung Kim; Sun Yoon; Chang Ki Jang; Sunghan Kim; JoonNyung Heo; Jung-Keun Lee; In Hwan Lim; Ji Hoe Heo; Hyo Suk Nam; Young Dae Kim

doi:10.3174/ajnr.A8598

Long-Term Outcome of Rescue Stenting for Acute Intracranial Atherosclerotic Stenosis Related Large Vessel Occlusion in Anterior Circulation

AJNR Am J Neuroradiol. 2024 Nov 22:ajnr.A8598. doi: 10.3174/ajnr.A8598. Online ahead of print.

Authors

Affiliation

¹ From the Department of Neurology (H.P.), Keimyung University School of Medicine, Daegue, Korea; Department of Radiology (B.M.K., D.J.K.), Interventional Neuroradiology, Department of Radiology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Department of Radiology (J-W.K.), Yonging Severance Hospital, Yonsei University College of Medicine, Yongin, Korea; Department of Radiology (J.W.K), Yonsei University Wonju Christian Hospital, Wonju, Korea; Department of Neurology (J-H.B), Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Neurosurgery (M.J.K), Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; Department of Neurosurgery (S.Y), Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea; Department of Neurosurgery (C.K.J), Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea; Department of Neurosurgery (S.K), Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; Department of Neurology (JN.H), Chung-Ang University, Gwangmeyong Hospital, Gwangmyeong, Korea; Department of Neurosurgery (J-K.K), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; Department of Neurology (I.H.L), Wonkwang University School of Medicine, Iksan, Korea; Department of Neurology (J.H.H., H.S.N., Y.D.K.), Yonsei University College of Medicine, Seoul, Korea.

PMID: 39578107
DOI: 10.3174/ajnr.A8598

Abstract

Background and purpose: Rescue stent (RS) is an accepted rescue option after failed mechanical thrombectomy (MT) for acute ischemic stroke due to intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion (LVO). However, the long-term outcomes (≥ 12 months) of RS have not yet been elucidated.

Materials and methods: We retrospectively analyzed the data of 154 patients with RS for ICAS-related LVO, which were identified from prospectively maintained multicenter database of RS after MT failure, to assess good outcome (mRS 0-2), mortality, stroke recurrence, symptomatic intracranial hemorrhage (SICH) and stent patency.

Results: Among 154 patients, successful recanalization was achieved in 132 (85.7%) after RS. Clinical follow-up was available in 148 patients at 3 months, of whom 126 were followed longer than 12 months. Good outcome was observed in 53.4% (79/148) at 3 months and 53.2% (67/126) at the final assessment among survivors (median [interquartile range (IQR)] months, 33 [13-91]). The overall incidence of mortality was 16.2% (24/148) Mortality occurred in 8.8% (13/148) of patients at 3 months and 8.7% (11/126) thereafter, respectively. Stroke recurrence was 0.7% (1/148) within 3 months and 3.2% (4/126) thereafter. The overall incidence of SICH was 9.5% (14/148). SICH occurred in 8.8% (13/148) within the first 3 months, and in 0.8% (1/126) thereafter. The stented vessel was patent in 81.1% (99/122) at the first follow-up (median [IQR] days, 3 [1-125]) and 96.7% (89/92) at the final follow-up (median [IQR] months, 18 [13-68]).

Conclusions: Patients with RS for ICAS-LVO showed a low stroke recurrence rate in the long term. The long-term patency of rescue stent appears to remain durable, particularly when it remains patent during the initial follow-upABBREVIATIONS: ICAS = intracranial atherosclerotic stenosis; LVO = large vessel occlusion; AIS = acute ischemic stroke; MT = mechanical thrombectomy; RS = rescue stenting; CT = computed tomography; MR = magnetic resonance; MMD = moyamoya disease; Intra-arterial = IA; Intravenous = IV; DAPT = dual antiplatelet therapy.