Effect Modification of Rescue Stenting in ICAS-Related Middle Cerebral Artery Occlusion: The Role of Thrombectomy Failure, Stenosis Severity, and ASPECTS

Year: 2026

Type: article

Abstract: Rescue stenting (RS) is increasingly used for intracranial artery stenosis-related large vessel occlusion (ICAS-LVO), but optimal patient selection remains uncertain. We investigated the baseline and procedural factors associated with receiving RS and whether they modified the association between RS and clinical outcome.This retrospective multicenter study included patients with middle cerebral artery (MCA) ICAS-LVO treated with mechanical thrombectomy (MT) alone or MT followed by RS. Baseline and procedural characteristics associated with receiving RS were identified using multivariable logistic regression and incorporated into inverse probability of treatment weighting models to assess treatment-effect heterogeneity for the 90-day modified Rankin Scale score.Among 264 patients, 193 received RS and 71 MT alone. MT failure, severe stenosis (> 75%), and higher baseline Alberta Stroke Program Early CT Score (ASPECTS) were independently associated with receiving RS. Both MT failure (interaction OR 0.28, 95% CI 0.10-0.83; p for interaction = 0.02) and severe stenosis (interaction OR 0.13, 95% CI 0.03-0.53; p for interaction = 0.004) significantly modified the association between RS and clinical outcome, whereas baseline ASPECTS did not. Within the MT failure subgroup, a significant interaction between severe stenosis and ASPECTS was observed (interaction OR 0.08, 95% CI 0.02-0.38; p for interaction = 0.002), suggesting a more favorable association between RS and outcome at higher ASPECTS values in patients with severe stenosis.In MCA ICAS-LVO, RS may be associated with more favorable outcomes in patients with MT failure, particularly in the presence of severe residual stenosis and preserved ASPECTS. These findings support a more selective approach to RS and warrant prospective validation.

Source: Translational Stroke Research

DOI: 10.1007/s12975-026-01496-9

Institutions: Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, Centre Hospitalier Universitaire Henri-Mondor, Hôpitaux Universitaires Henri-Mondor, Barking, Havering And Redbridge University Hospitals NHS Trust, University of Oxford, Queen's Hospital, Hôpital Foch, University of Science and Technology of China, Wannan Medical College, First Affiliated Hospital of Wannan Medical College, Azienda Ospedale - Università Padova, NYU Langone Health, New York University, Boston Medical Center, Azienda Ospedaliero-Universitaria Careggi, Ospedale Maggiore Carlo Alberto Pizzardi, Istituto delle Scienze Neurologiche di Bologna, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Ospedale Vito Fazzi, Policlinico Umberto I, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, Centre Hospitalier Universitaire de Rouen, Pitié-Salpêtrière Hospital, Centre Hospitalier Sud Francilien, Ospedale dell' Angelo, Azienda Ospedaliera Universitaria Integrata Verona, Ospedale Garibaldi, Azienda Ospedaliera Universitaria Policlinico "G. Martino", Fondazione Istituto Neurologico Nazionale Casimiro Mondino, Ospedale Policlinico San Martino, Ospedale Santa Corona, IRCCS Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele

Language: English

Topic: Acute Ischemic Stroke Management

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $5,490

Funder: Università Cattolica del Sacro Cuore

OpenAlex ID: W7214064101