Yingchun Wu, Hanzhang Wang, Yuejiang Gui, Rui Sun, Guanqing Feng, Wenzhao Li, Yanan Zheng, Wen Liu, Zhipeng Hua
The RESCUE technique is a safe and effective lesion-specific endovascular strategy for ICAS-LVO, providing superior FPR and shorter procedural time compared with the conventional Solumbra technique, without increasing safety concerns. Larger-scale multicenter investigations are needed to confirm these results.
BACKGROUND: Conventional mechanical thrombectomy (MT) for acute ischemic stroke (AIS) due to intracranial atherosclerosis-related large vessel occlusion (ICAS-LVO) is associated with low first-pass reperfusion (FPR), distal embolization, and recurrent thrombosis. We designed a novel stepwise endovascular strategy, the RESCUE (Retrievable stent-Endovascular tirofiban-paSs-ExtraCtion-microgUide-rEscue angioplasty) technique, and compared its safety and efficacy with that of the standard Solumbra technique.
METHODS: In this prospective, randomized, single-center trial, 85 patients presenting with AIS due to ICAS-LVO were enrolled consecutively. Eligible participants underwent randomization to either the RESCUE group (43 patients) or Solumbra group (42 patients). The primary endpoint was FPR, defined as achieving modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c-3. Secondary endpoints comprised: favorable 90-day functional status [modified Rankin Scale (mRS) score ≤2 for anterior strokes or ≤3 for posterior strokes]; procedural duration from groin puncture to first recanalization; number of retrieval attempts; distal embolization; early reocclusion; symptomatic intracranial hemorrhage (sICH); and death within 90 days.
RESULTS: A significant difference in FPR rates was observed between the two groups, favoring the RESCUE group [86.0% (37/43) vs. 61.9% (26/42); p = 0.011]. The RESCUE group had a shorter median procedural duration [40.0 min (interquartile range (IQR) 30.0-50.0 min) vs. 60.0 min (IQR 43.0-77.0 min); p = 0.010]. Successful reperfusion, defined as mTICI grade ≥2b, occurred in 93.0% of patients in the RESCUE group and 90.5% of those in the Solumbra group (p = 0.373). At the 90-day follow-up, a favorable functional outcome was noted in 60.5% (26/43) of RESCUE group patients and 57.1% (24/42) of Solumbra group patients (p = 0.483). No significant between-group differences emerged in the incidence of sICH (2.3% vs. 4.8%, p = 1.000) or 90-day mortality (0% vs. 4.8%, p = 0.237).
CONCLUSION: The RESCUE technique is a safe and effective lesion-specific endovascular strategy for ICAS-LVO, providing superior FPR and shorter procedural time compared with the conventional Solumbra technique, without increasing safety concerns. Larger-scale multicenter investigations are needed to confirm these results.