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

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. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05403593.