Collet-Vidiella Roger, Camps-Renom Pol, Núñez-Guillén Ana, Quesada Helena, Rizzo Federica, Rodriguez-Villatoro Noelia, Amaro Sergio, Llull Laura, Santana Daniel, Estrada Edgardo, Flores Alan, Terceño Mikel, Bashir Saima, Hernández-Pérez María, Remollo Sebastià, Barrachina-Esteve Oriol, Cánovas David, Vivas Elio, Rodríguez-Campello Ana, Mauri Gerard, Purroy Francisco, Ramos-Pachón Anna, Guasch-Jiménez Marina, Guisado-Alonso Daniel, Prats-Sánchez Luis, Martínez-Domeño Alejandro, Lambea-Gil Álvaro, Ezcurra-Díaz Garbiñe, Branera-Pujol Jordi, Martínez-González José Pablo, Dinia Lavinia, Salvat-Plana Mercè, Pérez de la Ossa Natalia, Molina Carlos A, Cardona Pere, Martí-Fàbregas Joan
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain.
Stroke Unit, Neurology Department, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Eur Stroke J. 2025 Jan 2:23969873241308680. doi: 10.1177/23969873241308680.
The efficacy of intracranial rescue stenting (RS) following failed mechanical thrombectomy (MT) in large-vessel occlusion (LVO) stroke remains uncertain. We aimed to evaluate clinical outcomes of RS in patients with anterior circulation LVO stroke following unsuccessful MT.
We conducted a retrospective analysis using the Stroke Code Registry of Catalonia (January 2016-March 2022), a prospective, population-based registry including patients treated at 10 comprehensive stroke centers. We compared outcomes between patients who received RS and those who did not after failed MT. The primary outcome was the shift in 90-day functional status, assessed by the modified Rankin Scale (mRS), adjusted for confounders using inverse probability of treatment weighting (IPTW). Secondary outcomes included good (mRS ⩽ 2 or 3 if baseline mRS was 3) and excellent (mRS ⩽ 1) outcomes, ischemic recurrences, hemorrhagic transformation, and 90-day mortality.
Of 601 patients, 69 underwent RS. RS did not significantly impact the 90-day mRS shift (adjusted common odds ratio [acOR] 1.06, [95% CI 0.85-1.32]; = 0.613). However, RS was associated with higher rates of good (18.8% vs 11.7%; aOR 1.41, [95% CI 1.00-1.99]; = 0.048) and excellent outcomes (17.4% vs 5.7%; aOR 2.90, [95% CI 1.89-4.43]; < 0.001). Symptomatic intracranial hemorrhage (9.4% vs 7.4%; = 0.507) and 90-day mortality (30.4% vs 39.8%; = 0.135) were similar between groups. Stroke recurrence (4.2% vs 1.7%; = 0.247) showed no significant difference at 33-month follow-up.
RS may increase the likelihood of good and excellent outcomes in anterior LVO stroke after failed MT, without increasing long-term risks. Further randomized trials are warranted for comprehensive validation.
在大血管闭塞（LVO）性卒中机械取栓（MT）失败后进行颅内挽救性支架置入术（RS）的疗效仍不确定。我们旨在评估MT失败后前循环LVO性卒中患者接受RS的临床结局。
我们使用加泰罗尼亚卒中编码登记处（2016年1月至2022年3月）进行了一项回顾性分析，这是一个基于人群的前瞻性登记处，纳入了在10个综合卒中中心接受治疗的患者。我们比较了接受RS的患者与MT失败后未接受RS的患者的结局。主要结局是90天功能状态的变化，采用改良Rankin量表（mRS）评估，并使用治疗权重逆概率（IPTW）对混杂因素进行校正。次要结局包括良好（如果基线mRS为3，则mRS≤2或3）和优异（mRS≤1）结局、缺血性复发、出血性转化和90天死亡率。
601例患者中，69例接受了RS。RS对90天mRS变化无显著影响（校正后的共同优势比[acOR]为1.06，[95%置信区间0.85 - 1.32]；P = 0.613）。然而，RS与更高的良好结局率（18.8%对11.7%；调整后的优势比[aOR]为1.41，[95%置信区间1.00 - 1.99]；P = 0.048）和优异结局率（17.4%对5.7%；aOR为2.90，[95%置信区间1.89 - 4.43]；P < 0.001）相关。两组间症状性颅内出血（9.4%对7.4%；P = 0.507）和90天死亡率（30.4%对39.8%；P = 0.135）相似。在33个月的随访中，卒中复发（4.2%对1.7%；P = 0.247）无显著差异。
RS可能增加MT失败后前循环LVO性卒中获得良好和优异结局的可能性，且不增加长期风险。需要进一步的随机试验进行全面验证。
