School of Medicine Publications
Comparative Safety and Efficacy of Balloon-Mounted and Self-Expanding Stents in Rescue Stenting for Large Vessel Occlusion: Secondary Analysis of the RESCUE-ICAS Registry
Document Type
Article
Publication Date
12-2025
Abstract
Background and purpose: Patients with intracranial stenosis-related large-vessel occlusion (ICAS-LVO) may experience better outcomes with stent placement compared with stand-alone mechanical thrombectomy (MT). This study evaluates the safety and clinical outcomes of self-expanding stents (SES) versus balloon-mounted stents (BMS) in patients with ICAS-LVO treated with MT and stent placement.
Materials and methods: This secondary analysis of the Registry of Emergent Large-Vessel Occlusion Due to Intracranial Stenosis, a multicenter observational study, included patients with ICAS-LVO from 25 stroke centers who underwent stent placement. Patients were stratified by stent type (SES or BMS). The primary end point was 90-day mRS = 0-2. Secondary outcomes included successful reperfusion, recurrent stroke, and infarct volume. Symptomatic intracranial hemorrhage was the primary safety outcome. Inverse probability-weighting was adjusted for confounders.
Results: Among 194 patients, 111 received SES, of whom 61 (55%) underwent prestenting angioplasty. After adjustment, no significant difference was observed among SES and BMS in 90-day mRS 0-2 (OR, 1.10; 95% CI, 0.62-1.96; P = .75), successful reperfusion (modified TICI ≥2b), or final infarct volume. SES were associated with higher odds of moderate stenosis (>50%) at follow-up (OR, 3.7; 95% CI, 1.15-11.98; P = .02) and recurrent stroke (13.5% versus 1.2%; P = .001), particularly in patients without prestenting angioplasty (14% versus 1%).
Conclusions: SES and BMS demonstrated comparable safety and clinical outcomes in patients with ICAS-LVO. However, SES were linked to higher rates of restenosis and recurrent strokes, potentially influenced by the absence of prestenting angioplasty. Further research is needed to refine stent-placement strategies in this population.
Recommended Citation
Al Kasab, S., Mierzwa, A. T., Tahhan, I. S., Yaghi, S., Jumaa, M., Inoa, V., Capassoe, F., Nahhas, M., Starke, R. M., Fragata, I., Bender, M. T., Moldovan, K., Maier, I., Grossberg, J. A., Jabbour, P., Psychogios, M., Samaniego, E. A., Burkhardt, J. K., Altschul, D., Mascitelli, J., … RESCUE-ICAS Collaborators (2025). Comparative Safety and Efficacy of Balloon-Mounted and Self-Expanding Stents in Rescue Stenting for Large Vessel Occlusion: Secondary Analysis of the RESCUE-ICAS Registry. AJNR. American journal of neuroradiology, 46(12), 2514–2520. https://doi.org/10.3174/ajnr.A8895
Publication Title
AJNR. American journal of neuroradiology
DOI
10.3174/ajnr.A8895
Academic Level
faculty
Mentor/PI Department
Neurology
Comments
© 2025 by American Journal of Neuroradiology.