Al Kasab Sami, Mierzwa Adam T, Tahhan Imad Samman, Yaghi Shadi, Jumaa Mouhammad, Inoa Violiza, Capasso Francesco, Nahhas Michael, Starke Robert M, Fragata Isabel, Bender Matthew T, Moldovan Krisztina, Maier Ilko, Grossberg Jonathan A, Jabbour Pascal, Psychogios Marios, Samaniego Edgar A, Burkhardt Jan-Karl, Altschul David, Mascitelli Justin, Ezzeldin Mohamad, Grandhi Ramesh, de Havenon Adam, Nguyen Thanh N, Hassan Ameer E
From the Neurosurgery and Neurology Department (S.A.K.,I.S.T.), Medical University of South Carolina,Charleston,SC,USA, Department of Neurology (A.T.M.,M.J.), University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA, Department of Neurology (S.Y.), Warren Alpert Medical School of Brown University, Providence, RI, USA, Semmes Murphey Clinic (V.I.), University of Tennessee Health Science Center, Memphis, TN, USA, Interventional Neuroradiology Department (F.C.), Azienda Ospedaliero-Universitaria Careggi, Florence, Italy, Department of Neurology (M.N.), University of Texas, Houston, Tx, USA, Department of Neurosurgery (R.M.S.), University of Miami, Miami, FL, USA, Department of Neuroradiology (I.F.), Hospital S. José, ULS, Lisbon, Portugal, Department of Neurosurgery (M.T.B.), University of Rochester Medical Center, Rochester, NY, USA, Department of Neurosurgery (K.M.), Warren Alpert Medical School of Brown University, Providence, RI, USA, Department of Neurology (I.M.), University Medicine Goettingen, Goettingen, NS, Germany, Department of Neurosurgery (J.A.G.), Emory University, Atlanta, GA, USA, Department of Neurosurgery (P.J.), Thomas Jefferson University, Philadelphia, PA, USA, Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine (M.P.), University Hospital Basel, Switzerland, Department of Neurology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City, IA, USA, Department of Neurosurgery (J.K.B.), University of Pennsylvania, PA, Philadelphia, USA, Department of Neurosurgery (D.A.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, Department of Neurosurgery (J.M.), University of Texas Health and Science Center, San Antonio, TX, USA, Neuroendovascular Surgery Department (M.E.), HCA Houston Healthcare Kingwood, Kingwood, TX, USA, Department of Neurosurgery (R.G.) University of Utah, Salt Lake City, UT, USA, Department of Neurology (A.D.H), Center for Brain and Mind Health, Yale University School of Medicine, New Haven, CT, USA, Department of Radiology and Neurology (T.N.N), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA, Department of Neurology (A.E.H.), University of Texas Rio Grande Valley -Valley Baptist Medical Center, Harlingen, TX, USA.
AJNR Am J Neuroradiol. 2025 Jun 27. doi: 10.3174/ajnr.A8895.
Patients with intracranial stenosis-related large vessel occlusion (ICAS-LVO) may experience better outcomes with stenting compared to standalone mechanical thrombectomy. This study evaluates the safety and clinical outcomes of self-expanding stents (SES) versus balloon-mounted stents (BMS) in ICAS-LVO patients treated with mechanical thrombectomy and stenting.
This secondary analysis of the RESCUE-ICAS registry, a multicenter observational study, included ICASLVO patients from 25 stroke centers who underwent stenting. Patients were stratified by stent type (SES or BMS). The primary endpoint was 90-day modified Rankin Scale (mRS) 0-2. Secondary outcomes included successful reperfusion, recurrent stroke, and infarct volume. Symptomatic intracranial hemorrhage was the primary safety outcome. Inverse probability weighting adjusted for confounders.
Among 194 patients, 111 received SES, of whom 61 (55%) underwent pre-stenting angioplasty. After adjustment, no significant difference was observed between SES and BMS in 90-day mRS 0-2 (OR 1.10, 95% CI 0.62-1.96, p=0.75), successful reperfusion (mTICI ≥2B), or final infarct volume. SES was associated with higher odds of moderate stenosis (>50%) at follow-up (OR 3.7, 95% CI 1.15-11.98, p=0.02) and recurrent stroke (13.5% vs. 1.2%, p=0.001), particularly in patients without pre-stenting angioplasty (14% vs. 1%).
SES and BMS demonstrated comparable safety and clinical outcomes in ICAS-LVO patients. However, SES was linked to higher rates of restenosis and recurrent strokes, potentially influenced by the absence of pre-stenting angioplasty. Further research is needed to refine stenting strategies in this population.
BMS = balloon mounted stents, ICAS = intracranial atherosclerotic stenosis, IPW = Inverse probability weighted, MT = mechanical thrombectomy, LVO = Large vessel occlusion, RS = rescue stenting, RESCUE-ICAS = Registry of Emergent Large Vessel Occlusion due to Intracranial Stenosis, SES = self-expanding stents (SES).
与单纯机械取栓相比，颅内狭窄相关大血管闭塞（ICAS-LVO）患者行支架置入术可能预后更佳。本研究评估了在接受机械取栓和支架置入术的ICAS-LVO患者中，自膨式支架（SES）与球囊扩张式支架（BMS）的安全性和临床结局。
本研究对多中心观察性研究RESCUE-ICAS注册研究进行二次分析，纳入了来自25个卒中中心接受支架置入术的ICAS-LVO患者。患者按支架类型（SES或BMS）分层。主要终点为90天改良Rankin量表（mRS）评分为0-2分。次要结局包括成功再灌注、复发性卒中及梗死体积。有症状性颅内出血是主要安全性结局。采用逆概率加权法对混杂因素进行校正。
在194例患者中，111例接受了SES，其中61例（55%）在支架置入术前进行了血管成形术。校正后，SES组与BMS组在90天mRS评分为0-2分（OR=1.10，95%CI 0.62-1.96，p=0.75）、成功再灌注（改良脑梗死溶栓分级[mTICI]≥2B级）或最终梗死体积方面未观察到显著差异。SES与随访时中度狭窄（>50%）（OR=3.7，95%CI 1.15-11.98，p=0.02）及复发性卒中（13.5%对1.2%，p=0.001）的较高发生率相关，尤其是在未进行支架置入术前血管成形术的患者中（14%对1%）。
在ICAS-LVO患者中，SES和BMS显示出相当的安全性和临床结局。然而，SES与较高的再狭窄率和复发性卒中相关，可能受未进行支架置入术前血管成形术的影响。需要进一步研究以优化该人群的支架置入策略。
BMS = 球囊扩张式支架，ICAS = 颅内动脉粥样硬化狭窄，IPW = 逆概率加权，MT = 机械取栓，LVO = 大血管闭塞，RS = 救援性支架置入术，RESCUE-ICAS = 颅内狭窄导致的紧急大血管闭塞注册研究，SES = 自膨式支架
