Safety of Emergent Intracranial Stenting after Thrombolysis: A Multicenter Matched Analysis

BACKGROUND AND PURPOSE: In patients with acute large vessel occlusion (LVO) of the MCA and underlying intracranial artery stenosis (ICAS), rescue stenting (RS) has been associated with better angiographic outcomes and higher rates of functional independence compared with mechanical thrombectomy (MT) alone. However, uncertainty exists regarding safety of RS in patients at higher risk for intracranial bleeding. The primary aim of this retrospective multicenter study was to compare safety outcomes between patients with acute ICAS-LVO of the MCA who underwent MT and RS with or without prior intravenous thrombolysis (IVT). Efficacy outcomes were assessed as a secondary aim.

MATERIALS AND METHODS: We screened the prospective databases of 26 stroke centers across Europe, the United States, and China for consecutive patients with acute MCA ICAS-LVO who received RS. Patients were divided into 2 groups based on prior administration of IVT: IVT/RS and no-IVT/RS. Propensity score matching (PSM), based on a set of covariates that also included periprocedural antiplatelet therapies, was used to estimate the effect of IVT treatment. Primary safety outcomes were the occurrence of symptomatic intracranial hemorrhage (sICH) and 90-day mortality.

RESULTS: After PSM, 52 pairs of patients were available for analysis. No significant differences were observed between the 2 groups regarding rates of sICH (11.5% in IVT/RS group versus 9.6% in no-IVT/RS group; OR = 1.2; 95% CI, 0.4–4.3; P = .75) and 90-day mortality (14.3% in the IVT/RS group versus 11.7% in the no-IVT/RS group; OR = 1.3; 95% CI, 0.4–4.2; P = .71). There were also no significant differences in the occurrence of parenchymal hemorrhage types 1 and 2, successful recanalization rates, and 90-day functional outcome.

CONCLUSIONS: The safety of RS in ICAS-LVO is not significantly affected by prior IVT administration. Furthermore, IVT does not result in improved recanalization and clinical outcome. These findings should be interpreted with caution and require validation through future randomized controlled studies.