Rescue versus First-Line Intracranial Stenting during Thrombectomy for Acute Ischemic Stroke: A Propensity-Weighted Analysis of the RESISTANT Registry.

DOI
Publisher DOI
PubMed ID
41608810
Abstract
Background: While rescue stenting (RS) is a recognized bailout strategy following failed endovascular thrombectomy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO), first-line stenting (FLS) has emerged as a potential alternative to avoid vascular injury and improve outcomes. However, direct comparisons between these strategies remain limited. We conducted a comparative analysis of FLS versus RS using data from a large, multicenter international registry to evaluate their relative safety and effectiveness. Methods: We conducted a comparative analysis of FLS versus RS using data from the RESISTANT registry, a multicenter, international, retrospective cohort of AIS patients treated with intracranial stenting during EVT (2016-2023). Patients were categorized by stenting strategy: FLS (stent placed without prior thrombectomy) or RS (stent placed after failed thrombectomy). The primary effectiveness outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 90 days; the primary safety outcome was symptomatic intracranial hemorrhage (sICH). Propensity score inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. Results: Among 827 patients, 723 were in the RS cohort (median age 67 years [IQR 59-77], 64.2% male) and 104 in the FLS cohort (median age 65.5 years [IQR 58.8-77], 72.1% male). Using FLS as the reference strategy, IPTW=adjusted analyses did not detect significant differences in functional independence (OR=0.64; 95% CI 0.38-1.07) or sICH (OR=0.93; 95% CI 0.34-2.59). No significant differences were observed in secondary outcomes including successful reperfusion, mortality, or procedural complications. In the anterior circulation cohort (n=589), outcomes were likewise comparable (functional independence: OR=0.62; 95% CI 0.60-1.25; sICH: OR=0.81; 95% CI 0.30-2.18). Similarly, in the posterior circulation cohort (n=234), no significant differences were found (functional independence: OR=0.82; 95% CI 0.32-2.10; sICH: OR=0.81; 95% CI 0.30-2.18). Conclusions: In this study, no significant differences in safety or effectiveness were detected between FLS and RS strategies during EVT for AIS. Prospective, randomized trials are needed to better define optimal treatment approaches.
Date Issued
2026-04
Publication Type
Article
Subject(s)
Language(s)
en
Author(s)
Rodriguez-Calienes, Aaron
Yavagal, Dileep R
Asdaghi, Negar
Olivé Gadea, Marta
Diana, Francesco
Geyik, Serdar
Senadim, Songul
Cervo, Amedeo
Salcuni, Andrea
Piano, Mariangela
Moreu, Manuel
López-Frías, Alfonso
Hassan, Ameer E
Miller, Samantha
Zapata-Arriaza, Elena
de Albóniga-Chindurza, Asier
Bergui, Mauro
Molinaro, Stefano
Sousa, João André
Gomes, Fabio Silva
Sargento-Freitas, Joao
Alexandre, Andrea M
Pedicelli, Alessandro
Hofmeister, Jeremy
Machi, Paolo
Scarcia, Luca
Kalsoum, Erwah
Amorim, José
Meira, Torcato
Ortega-Gutierrez, Santiago
Cruz-Criollo, Leonardo
Renieri, Leonardo
Capasso, Francesco
Bárcena-Ruiz, Eduardo
Seoane, David
Abdalkader, Mohamad
Klein, Piers
Perry da Câmara, Catarina
Fragata, Isabel R
Rodríguez Castro, José
Vega, Pedro
Ozdemir, Atilla Ozcan
Uysal Kocabaş, Zehra
Smajda, Stanislas
Al Salman, Sadiq Abbas
Khalife, Jane
Jovin, Tudor G
Biraschi, Francesco
Richetti, Francesca
Castro, Pedro
Albuquerque, Luis
Siddiqui, Adnan H
Jaikumar, Vinay
Navia, Pedro
Ntoulias, Nikolaos
Psychogios, Marios-Nikos
Velo, Mariano
Zamarro, Joaquin
De Paco, Gonzalo
Ashouri, Yazan
AlMajali, Mohammad
Arenillas, Juan F
Sierra-Gomez, Alicia
Romoli, Michele
Marto, João Pedro
Yaghi, Shadi
Ribo, Marc
Tomasello, Alejandro
Requena, Manuel
Additional Credits
Journal
Stroke
Publisher
Lippincott, Williams & Wilkins
ISSN
1524-4628
0039-2499
Access(Rights)
embargo
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