Abstract Body: Background: Acute intracranial stenting for the treatment of patients with large vessel occlusion in case of failed reperfusion or severe stenosis is a growing practice. Our aim was to explore the clinical and radiological outcome in a large multicenter and international registry.
Methods: The RESISTANT registry is a multicenter and international retrospective registry of patients with large vessel occlusion stroke that underwent intracranial stenting due an acute stroke from 2016 to 2023. Primary endpoints was clinical outcome at 90 days. Secondary efficacy endpoints were final reperfusion (mTICI 2b-3), and stent patency at 24 hours. Safety outcomes included procedural complications, symptomatic intracranial hemorrhage and in-hospital mortality.
Results: Among 890 patients enrolled, 862 fulfilled inclusion criteria. Median age was 67.0 years (IQR 59.0-77.0), 558 (64.7%) were males and median NIHSS was 12 (IQR 7.0-19.0). Occlusion location was proximal in 758 (87.9%) patients and anterior circulation was affected in 613 (71.1%) patients (390 M1-MCA, 142 terminal ICA). The indication for intracranial stenting was failed reperfusion (mTICI 0-2a) in 456 patients (52.9%). After intracranial stenting, successful recanalization was achieved in 764 (88.6%) with a reocclusion rate during admission of 11.9% and missing controls of 17.7%. The rate of symptomatic intracranial hemorrhage was 8.1%. At 90 days, the median mRS was 3 (IQR 1-6). Successful recanalization and regular flow after stenting were predictors of functional outcome at 90 days. No variables were independently associated with early reocclusion or symptomatic intracranial hemorrhage.
Conclusion: Acute intracranial stenting was an effective therapy for patients with failed reperfusion or severe stenosis. Successful reperfusion and regular flow after stenting predicted functional outcome. Prospective studies are warranted to confirm efficacy and safety.