Stenting After Failed EVT Tied to Better Stroke Outcomes

TOPLINEIntracranial stenting (ICS) after unsuccessful endovascular thrombectomy (EVT) was associated with improved functional outcomes and lower mortality at 90 days in patients with acute ischemic stroke due to middle cerebral artery (MCA) occlusion, a German study showed.METHODOLOGYResearchers conducted a retrospective study using data from the German Stroke Registry — Endovascular Treatment, involving consecutive patients undergoing EVT from 2015 to 2023.A total of 436 patients with acute ischemic stroke due to MCA occlusion were included after propensity score matching: 218 patients underwent ICS and 218 patients with failed reperfusion (modified Thrombolysis In Cerebral Infarction [mTICI] score < 2b) had no further endovascular treatment.The groups were propensity score matched based on age, pre-stroke modified Rankin Scale (mRS) score, baseline National Institutes of Health Stroke Scale score, comorbidities (atrial fibrillation and dyslipidemia), baseline Alberta Stroke Program Early CT Score, occlusion location, administration of intravenous thrombolysis, and number of passes.Researchers primarily assessed functional status at 90 days using the mRS. Safety outcomes included the occurrence of symptomatic intracranial hemorrhage (sICH), 90-day all-cause mortality, and the rate of malignant MCA infarction.TAKEAWAYAt 90 days, 39% of patients in the ICS group had a good functional outcome (mRS score, 0-2) vs 22% of those in the control group (P < .001). The median mRS score was 3 in the ICS group vs 5 in the control group.ICS was associated with a shift to lower mRS scores at 90 days in both unadjusted (common odds ratio, 0.52; P < .01) and adjusted analysis (adjusted common odds ratio, 0.41; P < .01).Reperfusion was successful (mTICI score, 2b-3) in 87% of patients after ICS and complete (mTICI score, 3) in 56%.Rates of sICH at 24 hours did not differ significantly between the groups. Malignant MCA infarction was less common with ICS (1% vs 8%; P < .01), and 90-day all-cause mortality was lower (26% vs 37%; P = .02).IN PRACTICE"These findings provide hypothesis-generating evidence supporting further investigation of ICS as a rescue strategy after failed EVT, although prospective randomized studies are needed to determine its efficacy and safety," the authors wrote.SOURCEThe study was led by Malte Konrad, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. It was published online on October 9 in the Journal of Neurology.LIMITATIONSResidual confounding could not be excluded, and the observational design limited causal conclusions. The findings could not be generalized to all thrombectomy patients or to those with successful reperfusion without stenting. Additionally, the registry did not capture data on antiplatelet and anticoagulation therapy after the procedure.DISCLOSURESThe study received no specific funding. Multiple authors reported having financial or other ties with various organizations including pharmaceutical and medical device companies. Details are provided in the original article.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.