Determinants of day-1 stent patency following rescue intracranial stenting in failed intracranial thrombectomy

Abstract

Introduction

This study aimed to identify factors affecting stent patency in patients treated with rescue intracranial stenting (RIS) for a refractory intracranial occlusion following mechanical thrombectomy (MT), focusing on antithrombotic regimens, and types of devices used.

Material and methods

Data from 14 university hospitals spanning from 2015 to 2021 were utilized, concentrating on patients who underwent MT in the anterior circulation. The primary outcome was stent patency on follow-up imaging at day 1.

Results

Throughout the study period, a total of 101 patients received RIS at 14 centers for refractory anterior large vessel occlusion (LVO). Amongst the 101 implanted stents, 18 were coronary and 83 were neuro-stents. Seventy-six patients were given a double antiplatelet (AP) regimen following stent implantation. After adjustment on LVO level (M1 vs. carotid), sex, susceptibility vessel sign, number of stent passes, follow-up AP, and coronary versus neuro-stent usage, the presence of follow-up dual antiplatelet regimen was independently linked to stent patency on follow-up imaging (p = .0016). The type of stent and other factors were not.

Conclusion

Our study shows that in patients treated with RIS in the context of failed MT, starting dual antiplatelet therapy is independently associated with stent patency on follow-up imaging at day 1. In this large series, we have not found evidence supporting the superiority of a specific class of antiplatelet drugs or a stent category, especially coronary versus neuro-stents. These results may inform the design of future clinical trials.