Abstract Body: Background:
Previous studies suggest that in patients who fail to recanalize with devices approved for mechanical thrombectomy, early bailout with intracranial stenting might lead to better outcomes. We aimed to investigate weather the number of previous failed thrombectomy attempts (FTA) impacts outcomes after stenting.
Methods: The RESISTANT registry is a multicenter and international retrospective registry of patients with large vessel occlusion stroke presenting within 24 hours of symptom onset that underwent intracranial stenting due an acute stroke from 2016 to 2023. Number of failed thrombectomy attempts (FTA) with approved devices, final recanalization (TICI 2b-3) and 90 days favorable outcome (mRS 0-2), symptomatic intracranial hemorrhage and in-hospital mortality were recorded.
Results: Among 890 patients enrolled, 862 fulfilled inclusion criteria. Median age was 67.0 years (IQR 59.0-77.0) and 558 (64.7%) were males. 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 median number of FTA before stenting was 2 [1-3]. Baseline characteristics associated with higher number of FTA are shown in the table. A higher number of FTA before stenting was associated with lower final recanalization (OR:0.66, 95%CI:0.55-0.79;p<0.001) and favorable outcome (OR: 0.78, 95%CI: 0.71.0.86;p<0.001). FTA was not associated to symptomatic intracranial hemorrhage or in-hospital mortality.

Conclusion:
The number of failed thrombectomy passes before definitive stenting negatively impacts procedural and clinical outcomes. Prompt identification of patients who are likely to require definitive stenting could minimize unnecessary reperfusion delays and enhance patient outcomes.