Short-term efficacy and safety of bailout angioplasty or stenting after thrombectomy: a multicentre real-world study

Background Bailout angioplasty or stenting (BAOS) has been proposed as a rescue strategy for patients with residual intracranial atherosclerotic stenosis (ICAS) after successful recanalisation by endovascular thrombectomy (EVT); however, the short-term effectiveness and safety of BAOS in this setting remain unclear. This study aimed to evaluate real-world outcomes of BAOS after EVT and to identify patient subgroups who may benefit from this strategy.Methods This multicentre retrospective cohort study was conducted in seven stroke centres in China. Patients with acute ischaemic stroke due to anterior circulation large vessel occlusion who achieved successful recanalisation after EVT and had underlying ICAS (≥50%) were included. The primary outcome was 90-day functional independence, defined as a modified Rankin Scale score of 0 to 2. Any intracerebral haemorrhage within 36 hours was assessed as safety outcomes.Results A total of 213 patients with residual large-vessel stenosis ≥50% after successful thrombectomy were included. BAOS was associated with a lower likelihood of functional independence at 90 days compared with EVT alone (67.4% vs 53.7%; adjusted OR=0.40, 95% CI 0.20 to 0.77; p=0.007). In addition, the incidence of any intracranial haemorrhage within 36 hours was significantly higher in the BAOS group than in the non-BAOS group (24.8% vs 4.3%; adjusted OR=7.08, 95% CI 2.41 to 26.81; p=0.001).Conclusion In patients with anterior circulation stroke who achieve successful reperfusion but have residual stenosis ≥50%, BAOS was associated with less favourable 90-day outcomes. The subgroup patterns observed may provide hypotheses to guide patient selection in future prospective studies.