Abstract Body: Background: Intracranial stenting is increasingly performed after thrombectomy failure. Stent selection and procedural strategies are heterogenous between centers. Our aim is to evaluate the clinical and radiological impact of stent design among these patients.
Methods: The RESISTANT registry is a multicenter, international, retrospective study of patients with acute ischemic stroke who underwent intracranial stenting from 2016 to 2023. This analysis compares outcomes based on stent type and evaluates the role of pre- and post-stenting angioplasty. The primary endpoint was 90-day good clinical outcome defined as modified Rankin Scale 0 to 2. Secondary outcomes included final reperfusion, and early stent patency (within 48 hours). Safety outcomes included procedural complications, symptomatic intracranial hemorrhage, and in-hospital mortality.
Results: Among 859 patients in the RESISTANT registry, 176 underwent intracranial stenting with balloon-mounted stent (BMS) and 683 with self-expandable stent (SES). The Vertebrobasilar location was more frequent in patients who received BMS (46.6% vs 24.0%, p<0.001); other baseline variables were similar between groups. Angioplasty was performed more frequently before (SES: 54.0% vs BMS: 39.2%, p<0.001) and after SES (SES: 21.1% vs BMS: 9.2%, p<0.001). Successful reperfusion (mTICI 2b-3) was similar between groups (BMS: 91.2% vs SES: 89.1%) and the rate of residual intracranial stenosis was higher in SES patients (57.1% vs 35.6%, p<0.001). Reocclusion, procedural complications and symptomatic intracranial hemorrhage rates were similar between groups. At 90 days, the rate of good clinical outcome was higher among those patients treated with SES (44.7% vs 29.5%, aOR 1.74 (95%ICI 1.07-2.82)).
Conclusions: Among patients who underwent rescue intracranial stenting, patients treated with self-expandable stents had a better outcome than patients treated with balloon-mounted stent at 90 days despite similar rates of symptomatic intracranial hemorrhage, successful recanalization and early reocclusion.