Emergency Intracranial Stenting in Acute Stroke: Predictors for Good Outcome and for Complications

Background: Stent-retriever thrombectomy (SRT) is the first-line therapy
in acute stroke with intracranial large vessel occlusion (LVO). However,
SRT may fail in patients with intracranial atherosclerotic stenosis or
dissection, where rescue stent angioplasty (RSA) may be the only treatment
option to achieve permanent recanalization. Purpose: This study aims at
identifying predictors for good outcome and for complications in a large
multicenter cohort of these patients. Methods: We performed a
retrospective analysis of patients with LVO who were treated with RSA
after SRT between 2012 and 2018 in seven neurovascular centers. We defined
two binary outcomes (yes/no): 1) functional clinical outcome after 90 days
(good (modified Rankin Scale (mRS) 0-2) and poor (mRS 4-6)) and 2)
symptomatic intracerebral hemorrhage (sICH) in the immediate
post-interventional phase. The impacts of clinical, radiological and
interventional parameters on outcome were analysed. Results: 210 patients
out of 4751 thrombectomies (4.4%) were included with 136 (64.8%) anterior
circulation and 74 (35.2%) patients with posterior circulation LVO.
 In 22 patients sICH occured, 19 (86.4%) after anterior and 3
(13.6%) after posterior circulation LVO. After 3 months 73 /163 (44.8%)
patients had a good clinical outcome.  A higher NIHSS at
admission (adjusted OR, 1.10, P=0.002), a higher premorbid mRS (adjusted
OR, 2.02, P =0.049) and a mTICI (modified thrombolysis in cerebral
infarction) score of 0-2a in the final run after stenting (adjusted OR,
23.24 per maneuvre, P <0.001) were independent predictors of poor
functional outcome. Conclusions: The use of RSA can be considered for
acute intracranial LVO in cases after unsuccessful SRT. The likelihood of
sICH is higher in anterior circulation stroke.