System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Multicenter Study Epublish

PubMed: 42773327 DOI: 10.1007/s12975-026-01496-9

Effect Modification of Rescue Stenting in ICAS-Related Middle Cerebral Artery Occlusion: The Role of Thrombectomy Failure, Stenosis Severity, and ASPECTS.

Transl Stroke Res 17(5)

Authors: Andrea M Alexandre, Luca Scarcia, Adam A Dmytriw, Valerio Brunetti, Arturo Consoli, Wen Sun, Yingjie Xu, Xianjun Huang, Joseph D Gabrieli, Charlotte Chung, Alessandro Sgreccia, Mohamad Abdalkader, Yan-Lin Li, Shruthika Kimavath, Mohd Shariq, Giovanni Frisullo, Nicola Limbucci, Francesco Arba, Alessandro Pedicelli, Mauro Gentile, Serena Abruzzese, Mariangela Piano, Maria P Ganimede, Emilio Lozupone, Chiara Gaudino, Riccardo Russo, Julien Burel, Julien Allard, Nicolas Chausson, Roberta Partesano, Nicola Cavasin, Nicolò Mandruzzato, Pietro Trombatore, Antonio A Caragliano, Federico Mazzacane, Giancarlo Salsano, Antioco Sanna, Pietro Panni, Andrea Zini, Frédéric Clarençon, Eytan Raz, Thanh N Nguyen, Aldobrando Broccolini

Affiliations

  • Interventional Neuroradiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.
  • Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK.
  • Queens Hospital, Institute of Therapeutic Neuroradiology, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK.
  • Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch, Suresnes, France.
  • Department of Neurology, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Hefei, Anhui, China.
  • Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, China.
  • Neuroradiology Unit, Padua University Hospital, Padua, Italy.
  • Department of Neurosurgery and Department of Radiology, NYU Langone Health, New York, NY, USA.
  • Department of Radiology and Neurology, Boston Medical Center, Boston, MA, USA.
  • Interventional Neurovascular Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
  • Stroke Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
  • Department of Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy.
  • Neuroradiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Neuroradiology Unit, Presidio Ospedaliero Centrale SS Annunziata, Taranto, Italy.
  • Neuroradiology Unit, Hospital Vito Fazzi, Lecce, Italy.
  • Department of Neuroradiology, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy.
  • Neuroradiology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy.
  • Department of Radiology, Rouen University Hospital, Rouen, France.
  • Department of Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France.
  • Department of Neurology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France.
  • Neuroradiology Unit, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.
  • Neuroradiology Unit, Ospedale dell'Angelo, Mestre, Italy.
  • Interventional Neuroradiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
  • Department of Diagnostic Imaging and of Interventional Radiology and Neuroradiology, Azienda Ospedaliera Garibaldi, Catania, Italy.
  • Neuroradiology Unit, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy.
  • Department of Stroke Unit and Emergency Neurology, IRCCS Mondino Foundation, Pavia, Italy.
  • Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
  • Neuroradiology Unit, Santa Corona Hospital, Pietra Ligure, Italy.
  • Interventional Neuroradiology Unit, IRCCS San Raffaele University Hospital, Milan, Italy.
  • Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Department of Neuroscience, Catholic University School of Medicine, Rome, Italy.

Abstract

Rescue stenting (RS) is increasingly used for intracranial artery stenosis-related large vessel occlusion (ICAS-LVO), but optimal patient selection remains uncertain. We investigated the baseline and procedural factors associated with receiving RS and whether they modified the association between RS and clinical outcome.This retrospective multicenter study included patients with middle cerebral artery (MCA) ICAS-LVO treated with mechanical thrombectomy (MT) alone or MT followed by RS. Baseline and procedural characteristics associated with receiving RS were identified using multivariable logistic regression and incorporated into inverse probability of treatment weighting models to assess treatment-effect heterogeneity for the 90-day modified Rankin Scale score.Among 264 patients, 193 received RS and 71 MT alone. MT failure, severe stenosis (> 75%), and higher baseline Alberta Stroke Program Early CT Score (ASPECTS) were independently associated with receiving RS. Both MT failure (interaction OR 0.28, 95% CI 0.10-0.83; p for interaction = 0.02) and severe stenosis (interaction OR 0.13, 95% CI 0.03-0.53; p for interaction = 0.004) significantly modified the association between RS and clinical outcome, whereas baseline ASPECTS did not. Within the MT failure subgroup, a significant interaction between severe stenosis and ASPECTS was observed (interaction OR 0.08, 95% CI 0.02-0.38; p for interaction = 0.002), suggesting a more favorable association between RS and outcome at higher ASPECTS values in patients with severe stenosis.In MCA ICAS-LVO, RS may be associated with more favorable outcomes in patients with MT failure, particularly in the presence of severe residual stenosis and preserved ASPECTS. These findings support a more selective approach to RS and warrant prospective validation.

MeSH

Constriction, Pathologic, Stroke, Cerebral Arteries, Arteries, Middle Cerebral Artery, Therapeutics, Thrombectomy