Outcomes of stenting after failed basilar artery thrombectomy for acute stroke: a nationwide registry-based cohort study

BACKGROUND: Mechanical thrombectomy is the most effective treatment for restoring reperfusion in large vessel occlusion acute ischaemic stroke, even in patients with posterior circulation. However, the strategy for optimal treatment of patients with acute basilar artery occlusion (BAO) in difficult-to-treat cases in which thrombectomy has failed is unknown. AIMS: The purpose of this study was to evaluate the clinical efficacy and safety of rescue intracranial stenting (RIS) in patients with acute BAO treated with thrombectomy. METHODS: Stroke patients with acute BAO who had undergone failed mechanical thrombectomy in the ATTENTION registry were enrolled in this study. Univariable and multivariable regression analyses were performed to assess the clinical efficacy and safety of RIS. RESULTS: A total of 477 patients were included in the analysis, and 346 patients underwent RIS, of whom 167 (35.0%) patients had a favourable outcome. Symptomatic intracranial haemorrhage (sICH) occurred in 24 (5.0%) patients, and 172 (36.1%) patients died. There were no significant differences between the two groups of patients in the outcomes of modified Rankin Scale (mRS) 0-1 (p=0.541), mRS 0-2 (p=0.374), mRS 0-3 (p=0.600), or death (p=0.706). Patients in the RIS+ group had a significantly higher incidence of sICH (1.5% vs 6.4%; p=0.031). Nevertheless, after adjusting for confounders, RIS was not found to be an independent risk factor for sICH (adjusted odds ratio 4.189, 95% confidence interval: 0.960-18.286; p=0.057). CONCLUSIONS: In this national, multicentre, prospective study, RIS in patients with acute BAO who had undergone failed first-line thrombectomy was feasible, but we could not show significance regarding improved long-term outcomes. Trial registration number: ChiCTR2000041117.