Clinical outcome after rescue intracranial stenting: a comparison of the ACCLINO flex and the CREDO heal stenting platforms after failed mechanical thrombectomy.

PURPOSE: Mechanical thrombectomy (MT) is the first-line therapy for patients with acute ischemic stroke due to large vessel occlusion; however, despite substantial advances in MT techniques and devices, mechanical recanalization remains unsuccessful in up to 15% of patients. Intracranial rescue stenting represents a promising option to achieve successful recanalization and good clinical outcomes in patients with failed MT. METHODS: In this retrospective, observational single-center analysis 77 consecutive patients who underwent failed MT and a maximum of 4 unsuccessful device passes were included. The ACCLINO flex stent / CREDO® heal stent were used in 38 / 39 patients. The study endpoint was a clinically favorable outcome defined as mRS ≤ 3 at 90 days. RESULTS: A clinically favorable outcome was achieved in 64.1% (25/39) of patients treated with the CREDO heal stent and in 39.5% (15/38) of patients treated with the ACCLINO flex stents (p = 0.031). Rescue stenting with the CREDO heal stent (aOR 3.51 95% CI 1.11-11.13, p = 0.033), baseline NIHSS (aOR 0.97 95% CI 0.85-0.97, p = 0.005) and pmRS (aOR 0.52 95% CI 0.31-0.89, p = 0.016) were independently associated with a favorable clinical outcome. Baseline characteristics did not differ between both groups. CONCLUSIONS: This study suggests that the design of the implanted stent device may influence the clinical outcome. Features such as optimized radial force and thrombogenicity-reducing surfaces of stents used for RIS may improve clinical outcomes of patients treated with intracranial rescue stenting in unsuccessful MT. These findings are hypothesis-generating and require confirmation in prospective, randomized studies.