Rescue Stenting after Unsuccessful Recanalization of Endovascular Thrombectomy of the Posterior Circulation: A Systematic Review and Meta Analysis

Background: The role of rescue stenting (RS) in acute ischemic strokes due to intracranial atherosclerotic disease-related large vessel occlusion is an area of active investigation. This study evaluates the efficacy and safety of RS under these circumstances. Methods: A systematic literature review, conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted across PubMed, EMBASE, Cochrane, and OVID databases. Common and random effects analyses were conducted to compare outcomes including modified Rankin Scale score, 90-day mortality, and symptomatic intracranial hemorrhage between patients receiving and those not receiving RS after failed endovascular thrombectomy within posterior circulation. Results: Ten studies comprising 1202 patients (730 RS, 472 control) were analyzed. RS was associated with a statistically significant improvement in functional outcomes, evidenced by a higher proportion of patients achieving modified Rankin Scale score <= 2 at 90 days (32.74% versus 21.19% in controls; P<0.001). Additionally, RS showed a significant reduction in 90-day mortality (33.28% versus 54.66% in controls; P<0.001) and a lower incidence of symptomatic intracranial hemorrhage (3.74% versus 9.49% in controls; P<0.001). Conclusion: RS for acute ischemic stroke in the context of intracranial atherosclerotic diseaserelated posterior circulation large vessel occlusion after failed endovascular thrombectomy is associated with improved functional outcomes, reduced mortality, and decreased symptomatic intracranial hemorrhage rates. These findings suggest RS as a beneficial intervention in this patient population. However, the retrospective nature of the included studies and their heterogeneity underline the need for further research, particularly through randomized controlled trials.