Abstract DP342: Rescue versus First-Line Intracranial Stenting during Thrombectomy for Acute Ischemic Stroke: A Propensity-Weighted Analysis of the RESISTANT Registry

Introduction: Rescue stenting (RS) is a recognized bailout strategy following failed endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). First-line stenting (FLS) has emerged as a potential alternative to avoid vascular injury and improve outcomes. However, direct comparisons between these strategies remain limited. Methods: We conducted a comparative analysis of FLS and RS using data from the RESISTANT registry, an international, multicenter, retrospective cohort of AIS patients who received intracranial stenting during EVT from 2016 to 2023. Patients were categorized by stenting strategy: FLS (stent placed without prior thrombectomy) or RS (stent placed after failed thrombectomy). The primary effectiveness outcome was functional independence (modified Rankin Scale [mRS] 0–2) at 90 days. The primary safety outcome was symptomatic intracranial hemorrhage (sICH). Propensity score inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. Results: Among 827 patients, 723 were in the RS cohort and 104 in the FLS cohort. Compared to RS, FLS patients more often had diabetes (46.2% vs. 35.2%, p =0.03), prior stroke (46.2% vs. 25.3%, p <0.001), prior antiplatelet use (50.0% vs. 27.7%, p <0.001), and known ICAS (28.8% vs. 6.0%, p <0.001). They also had lower baseline NIHSS scores at presentation (median 8 vs. 14, p <0.001) and shorter onset-to-recanalization times (median 363 vs. 392 min, p =0.006). After IPTW adjustment, functional independence was similar between groups (OR=0.64; 95% CI 0.38–1.07), as was the risk of sICH (OR=0.93; 95% CI 0.34–2.59). No significant differences were observed in secondary outcomes including successful reperfusion, mortality, or procedural complications. Outcomes were similar in both the anterior circulation subgrou (n=589; functional independence: OR=0.62; 95% CI 0.60–1.25; sICH: OR=0.81; 95% CI 0.30–2.18) and the posterior circulation subgroup (n=234; functional independence: OR=0.82; 95% CI 0.32–2.10; sICH: OR=0.81; 95% CI 0.30–2.18). Conclusion: FLS and RS strategies during EVT for AIS demonstrated comparable safety and efficacy. Prospective, randomized trials are needed to better define optimal treatment approaches.

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Journal
Stroke
Published
2026-01-29
DOI
https://doi.org/10.1161/str.57.suppl_1.dp342
Primary Topic
Intracranial Aneurysms: Treatment and Complications
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article

Abstract DP342: Rescue versus First-Line Intracranial Stenting during Thrombectomy for Acute Ischemic Stroke: A Propensity-Weighted Analysis of the RESISTANT Registry

J. Zamorro Parra, Andrea Salcuni, Aaron Rodriguez Calienes, Stefano Molinaro et al.
Stroke
Intracranial Aneurysms: Treatment and Complications
article

Abstract DP342: Rescue versus First-Line Intracranial Stenting during Thrombectomy for Acute Ischemic Stroke: A Propensity-Weighted Analysis of the RESISTANT Registry

J. Zamorro Parra, Andrea Salcuni, Aaron Rodriguez Calienes, Stefano Molinaro, Catarina Perry da Câmara, E. Kalsoum, Manuel Requena, Jude Hassan Charles, Jérémy Hofmeister, D Yavagal, Fabiano Cavalcante, Fábio Gomes, M Piano, A Tomasello, Isabel Fragata, Mohammad AlMajali, José Rodríguez Castro, Mauro Bergui, Luca Scarcia, Ameer E Hassan, Adnan Mujanovic, Leonardo Cruz-Criollo, Gonzalo de Paco, João André Sousa, Francesco Diana, Alfonso López-Frías, David Seoane, Jose Amorim, Asier de Albóniga-Chindurza, Amedeo Cervo, Eduardo Barcena, Pedro Vega, Songul Senadim, Manuel Moreu, Mariano Velo, Francesco Capasso, Joao Pedro Marto, Yazan Ashouri, Zehra Uysal Kocabaş, Paolo Machi, Mohamad AbdalKader, Juan Arenillas, Daniele G. Romano, Santiago Ortega-Gutierrez, Andrea M. Alexandre, Leonardo Renieri, Shadi Yaghi, João Paulo Freitas, Marc Ribo, Alessandro Pedicelli, Piers Klein, Michele Romoli, Samantha Miller, Atilla Ozcan Ozdemir, serdar geyik, Alicia Sierra-Gomez, Johannes Kaesmacher, Thanh N. Nguyen, Elena Zapata-Arriaza
article en

Abstract

Introduction: Rescue stenting (RS) is a recognized bailout strategy following failed endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). First-line stenting (FLS) has emerged as a potential alternative to avoid vascular injury and improve outcomes. However, direct comparisons between these strategies remain limited. Methods: We conducted a comparative analysis of FLS and RS using data from the RESISTANT registry, an international, multicenter, retrospective cohort of AIS patients who received intracranial stenting during EVT from 2016 to 2023. Patients were categorized by stenting strategy: FLS (stent placed without prior thrombectomy) or RS (stent placed after failed thrombectomy). The primary effectiveness outcome was functional independence (modified Rankin Scale [mRS] 0–2) at 90 days. The primary safety outcome was symptomatic intracranial hemorrhage (sICH). Propensity score inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. Results: Among 827 patients, 723 were in the RS cohort and 104 in the FLS cohort. Compared to RS, FLS patients more often had diabetes (46.2% vs. 35.2%, p =0.03), prior stroke (46.2% vs. 25.3%, p <0.001), prior antiplatelet use (50.0% vs. 27.7%, p <0.001), and known ICAS (28.8% vs. 6.0%, p <0.001). They also had lower baseline NIHSS scores at presentation (median 8 vs. 14, p <0.001) and shorter onset-to-recanalization times (median 363 vs. 392 min, p =0.006). After IPTW adjustment, functional independence was similar between groups (OR=0.64; 95% CI 0.38–1.07), as was the risk of sICH (OR=0.93; 95% CI 0.34–2.59). No significant differences were observed in secondary outcomes including successful reperfusion, mortality, or procedural complications. Outcomes were similar in both the anterior circulation subgrou (n=589; functional independence: OR=0.62; 95% CI 0.60–1.25; sICH: OR=0.81; 95% CI 0.30–2.18) and the posterior circulation subgroup (n=234; functional independence: OR=0.82; 95% CI 0.32–2.10; sICH: OR=0.81; 95% CI 0.30–2.18). Conclusion: FLS and RS strategies during EVT for AIS demonstrated comparable safety and efficacy. Prospective, randomized trials are needed to better define optimal treatment approaches.

StrokeVol. 57(Suppl_1)
University of Messina (IT), Boston Medical Center (US), University of Miami (US), Istanbul Aydın University (TR), University Hospital of Bern (CH), University of Iowa Hospitals and Clinics (US), The University of Texas Rio Grande Valley (US), Agostino Gemelli University Polyclinic (IT), Hospital Clínico San Carlos (ES), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Unidade Local de Saúde de São José (PT), 5T Torino (Italy) (IT), Hospital Universitario 12 De Octubre (ES), University Hospital of Geneva (CH), Hospital de Egas Moniz (PT), Fundación Marques de Valdecilla (ES), Azienda Ospedaliero-Universitaria Careggi (IT), Vall d'Hebron Hospital Universitari (ES), Bon Secours Mercy Health (US), Hôpitaux Universitaires Henri-Mondor (FR), Valley Baptist Medical Center (US), Hospital Universitario Central de Asturias (ES), Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona (IT), Hospital Braga (PT), Hackensack Meridian Health (US), Hospital Valle del Nalón (ES), Hospital Universitario Virgen de la Arrixaca (ES), Amsterdam University Medical Centers (NL), Hospital Universitario Virgen del Rocío (ES), Hospital Clínico Universitario de Valladolid (ES), Florida Cancer Care (US), Eskişehir Osmangazi University (TR), University of Turin (IT), University of Coimbra (PT), Sapienza University of Rome (IT)
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Intracranial Aneurysms: Treatment and Complications
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