Intracranial rescue stenting in the German stroke registry: a propensity score-matched multicenter study

Abstract Background Intracranial stenting (ICS) is used as a rescue strategy in patients with failed reperfusion after endovascular thrombectomy (EVT). However, real-world data on clinical outcomes and safety remain limited. Methods This retrospective analysis of prospectively collected data from the German Stroke Registry—Endovascular Treatment (GSR-ET) included patients with acute ischemic stroke due to middle cerebral artery (MCA) occlusion treated between June 2015 and December 2023. Patients undergoing ICS were compared with a 1:1 propensity score–matched cohort with failed reperfusion after EVT (final modified Thrombolysis in Cerebral Infarction [mTICI] score <2b) who received no further endovascular treatment. Functional, safety, and subgroup outcomes were assessed. Results Among the 14,714 eligible patients, ICS was performed in 352 (2.4%). After matching, 218 patients undergoing ICS were compared with 218 controls with failed reperfusion. ICS was associated with a shift toward better 90-day functional outcomes in unadjusted (cOR 0.52, 95% CI 0.37–0.73; p <0.01) and adjusted analyses (acOR 0.41, 95% CI 0.29–0.59; p <0.01). Malignant MCA infarction occurred less frequently in the ICS group (1% vs. 8%; p <0.01), as did 90-day mortality (26% vs. 37%; p =0.02). Symptomatic intracranial hemorrhage did not differ between groups (4% vs. 5%; p =0.63). Conclusions Patients treated with ICS had a shift toward better functional outcomes and lower 90-day mortality than those with failed reperfusion who received no further endovascular treatment. Symptomatic intracranial hemorrhage did not differ between groups. These findings support further investigation of ICS after failed EVT, although randomized studies are needed to determine its efficacy and safety.

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Journal
Journal of Neurology
Published
2026-10-09
DOI
https://doi.org/10.1007/s00415-026-14180-7
Primary Topic
Acute Ischemic Stroke Management
Type
article
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article

Intracranial rescue stenting in the German stroke registry: a propensity score-matched multicenter study

Hanna Zimmermann, Christian J. Thaler, Tobias Djamsched Faizy, Fee Keil et al.
Journal of Neurology
Acute Ischemic Stroke Management
article

Intracranial rescue stenting in the German stroke registry: a propensity score-matched multicenter study

Hanna Zimmermann, Christian J. Thaler, Tobias Djamsched Faizy, Fee Keil, Susanne Gellißen, Till Illies, Götz Thomalla, Christian Heitkamp, Helge C. Kniep, Maximilian Schell, Steffen Tiedt, Klaus Gröschel, Caspar Brekenfeld, Fabian Flottmann, Lukas Meyer, Lars Kellert, Felix Schlicht, Laurens Winkelmeier, Gabriel Broocks, Sven Thonke, Matthias Bechstein, Timo Uphaus, Jens Fiehler, Tobias Boeckh‐Behrens, Mario Abruscato, Silke Wunderlich, Vincent Geest, Alexander Heitkamp, Bogdana Tokareva, Albrecht Bormann, Jan Hendrik Schäfer, Jörg Berrouschot, Luca Meucci, Gregor Peter, Ulrike Ernemann, Anna Alegiani, Alexander Nave, for the German Stroke Registry -Endovascular Treatment (GSR-ET), Annerose Mengel, Gabor Petzold, Malte Konrad, Charlotte Weyland, Christian Nolte, Franziska Dorn, Arno Reich, Charlotte Pietrock, Eberhard Siebert, Robert Schulz
article en

Abstract

Abstract Background Intracranial stenting (ICS) is used as a rescue strategy in patients with failed reperfusion after endovascular thrombectomy (EVT). However, real-world data on clinical outcomes and safety remain limited. Methods This retrospective analysis of prospectively collected data from the German Stroke Registry—Endovascular Treatment (GSR-ET) included patients with acute ischemic stroke due to middle cerebral artery (MCA) occlusion treated between June 2015 and December 2023. Patients undergoing ICS were compared with a 1:1 propensity score–matched cohort with failed reperfusion after EVT (final modified Thrombolysis in Cerebral Infarction [mTICI] score <2b) who received no further endovascular treatment. Functional, safety, and subgroup outcomes were assessed. Results Among the 14,714 eligible patients, ICS was performed in 352 (2.4%). After matching, 218 patients undergoing ICS were compared with 218 controls with failed reperfusion. ICS was associated with a shift toward better 90-day functional outcomes in unadjusted (cOR 0.52, 95% CI 0.37–0.73; p <0.01) and adjusted analyses (acOR 0.41, 95% CI 0.29–0.59; p <0.01). Malignant MCA infarction occurred less frequently in the ICS group (1% vs. 8%; p <0.01), as did 90-day mortality (26% vs. 37%; p =0.02). Symptomatic intracranial hemorrhage did not differ between groups (4% vs. 5%; p =0.63). Conclusions Patients treated with ICS had a shift toward better functional outcomes and lower 90-day mortality than those with failed reperfusion who received no further endovascular treatment. Symptomatic intracranial hemorrhage did not differ between groups. These findings support further investigation of ICS after failed EVT, although randomized studies are needed to determine its efficacy and safety.

Journal of NeurologyVol. 273(11)
University of Münster (DE), MSH Medical School Hamburg – University of Applied Sciences and Medical University (DE), University Hospital Münster (DE), University Medical Center Hamburg-Eppendorf (DE)
Openalex Percentile: Top 12%
Acute Ischemic Stroke Management
DOIOpen Access PDFOpenAlex
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