Efficacy of Rescue Therapy After Failed Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis
Hany Atwan1, Abdallah Abbas2, Ibrahim Serag3
1Faculty of Medicine, Assiut University, Assiut, Egypt, 2Faculty of Medicine, Al-Azhar University, Damietta, Egypt, 3Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Objective:
This systematic review and meta-analysis aimed to assess the efficacy and safety of rescue stenting, comparing it to standard medical management.
Background:
Acute ischemic stroke (AIS) due to large vessel occlusion is a major cause of global morbidity and mortality. Mechanical thrombectomy (MT) is an established treatment; however, up to 20% of patients fail to achieve successful reperfusion. Rescue intracranial stenting has emerged as a promising strategy to improve outcomes in these challenging cases.
Design/Methods:
We conducted a systematic search of databases including PubMed, Scopus, Web of Science, and Cochrane, up to August 2024. A total of 30 studies involving patients who underwent rescue stenting after failed MT were included in the meta-analysis.
Results:
Rescue intracranial stenting showed significant improvements across all primary outcomes. Patients in the stent group were significantly more likely to achieve functional independence at 90 days, with 49.9% (95% CI: 43.4% to 56.3%) reaching this outcome, corresponding to a Risk Ratio (RR) of 1.85 (95% CI: 1.34–2.65, P < 0.0002). Mortality was lower in the stent group at 16.7% (95% CI: 13% to 21.1%), compared to medical management, with an RR of 0.72 (95% CI: 0.63–0.82, P > 0.00001). Symptomatic intracranial hemorrhage (sICH) was also reduced in the stent group, occurring in 8.2% of patients (95% CI: 6.5% to 10.3%), with an RR of 0.75 (95% CI: 0.75–0.99, P = 0.04). Recanalization rates, measured by mTICI scores, were significantly higher in the stent group, with an 84.4% success rate (95% CI: 78.4% to 89%), and an odds ratio (OR) of 4.28 (95% CI: 2.08–8.79, P < 0.0001). Reocclusion occurred in 13.4% of patients (95% CI: 4.9% to 31.6%).
Conclusions:
Rescue intracranial stenting offers significant clinical benefits for patients with failed MT, strongly supporting its incorporation into clinical practice for selected patients.
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