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REVIEW

Rescue stenting in refractory mechanical thrombectomy: A review

Noor A. Mahmoud1 ,  Mohamad Abdalkader2 ,  Sami Al Kasab3 ,  Adam de Havenon4 ,  Xu Tong5 ,  Baixue Jia5 ,  Piers Klein2 ,  Marios Psychogios6 ,  Urs Fischer7 ,  Zhongrong Miao5 ,  Thanh N. Nguyen2*
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1 Department of Neurology, School of Medicine, University of Oklahoma, Oklahoma City, Oklahoma, United States of America
2 Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, United States of America
3 Department of Neurology and Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, United States of America
4 Department of Neurology, Center for Brain and Mind Health, Yale University School of Medicine, New Haven, Connecticut, United States of America
5 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
6 Department of Diagnostic and Interventional Neuroradiology, Radiology and Nuclear Medicine Clinic, University Hospital Basel, Basel, Switzerland
7 Department of Neurology, University Hospital Bern, Bern University Hospital, Bern, Switzerland
Advanced Neurology 2024, 3(3), 3950 https://doi.org/10.36922/an.3950
Submitted: 15 June 2024 | Accepted: 15 August 2024 | Published: 10 September 2024
(This article belongs to the Special Issue Advances in stroke research and therapy)
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Despite advancements in mechanical thrombectomy (MT) in the treatment of large vessel occlusions, failure to achieve recanalization remains a challenge in 10 – 30% of patients. Several underlying pathologies have been postulated in refractory MT, including intracranial atherosclerotic stenosis, intracranial dissection, and recalcitrant emboli. Rescue strategies to maximize recanalization rates, such as alternative access routes, local thrombolysis, stent-assisted angioplasty, and acute “rescue” stenting, have been proposed. Considered an emerging treatment strategy for refractory MT, rescue stenting (RS) has been shown in non-randomized observational studies as a safe and effective strategy for increasing reperfusion rates and consequently improving clinical outcomes. The effective use of RS approach requires consideration of patient-specific characteristics, clot characteristics, and lesion anatomy. This review provides an overview of the understanding of refractory MT, epidemiology, pathophysiology, current evidence supporting RS in the anterior and posterior circulation, stents used, endovascular techniques, patient selection criteria, antithrombotic use, risks, and complications.

Keywords
Rescue stenting
Mechanical thrombectomy
Recanalization
Large vessel occlusion
Funding
None.
Conflict of interest
Thanh N. Nguyen is an Associate Editor of Stroke: Advisory Board for Brainomix, Aruna Bio, but has no known competing financial interests or personal relationships that could have influenced the work reported in this paper. Separately, other authors declared that they have no known competing interests.
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Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing
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