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Purpose <p>Mechanical thrombectomy (MT) is standard care for acute large vessel occlusion (LVO), but it fails in 10–20% of cases, often due to underlying intracranial artery stenosis (ICAS). In such cases, rescue stenting (RS), with or without angioplasty, may improve recanalization, but its clinical benefit remains debated. The purpose of this study was to define predictors of clinical outcome in this patient population.</p> Methods <p>We conducted a&#xa0;retrospective multicenter study including 115 patients with ICAS-related occlusion of the middle cerebral artery (MCA) treated with MT and RS across 27&#xa0;international stroke centers. Baseline, procedural, and post-procedural variables were analyzed. The outcome measure was the ordinal shift of the 90-day modified Rankin Scale (mRS) score. Stepwise multivariate regression and structural equation modeling (SEM) were used to identify outcome predictors and explore mediation pathways.</p> Results <p>Successful recanalization (modified Treatment in Cerebral Infarction (mTICI) score ≥ 2b) was achieved in 94.8% of patients, with 73.0% reaching mTICI&#xa0;2c‑3. SEM showed that baseline Alberta Stroke Program Early CT Score (ASPECTS), stenting with angioplasty and achieving mTICI&#xa0;2c‑3 were associated with improved functional outcome, mediated by higher post-procedural ASPECTS. Post-procedural ASPECTS influenced functional outcome both directly (estimate = −0.45, <i>p</i> &lt; 0.001) and indirectly by reducing the occurrence of symptomatic intracranial hemorrhage (sICH) (estimate = −0.09, <i>p</i> = 0.004). This model explained 36.5% of the variance in 90-day mRS scores.</p> Conclusion <p>In patients with acute ICAS-related MCA occlusion, stenting with angioplasty and achieving mTICI&#xa0;2c–3 recanalization are associated with improved clinical outcome. These benefits are mediated by better post-procedural ASPECTS and reduced sICH. Prospective studies are warranted to confirm these findings.</p>

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Impact of Stenting with Angioplasty and MTICI 2c-3 Recanalization On Outcome in Acute MCA Occlusion with Underlying Stenosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月13日

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  • Andrea Maria Alexandre,
  • Arturo Consoli,
  • Luca Scarcia,
  • Enrico Di Stasio,
  • Valerio Brunetti,
  • Wen Sun,
  • Yingjie Xu,
  • Xianjun Huang,
  • Charlotte Chung,
  • Alessandro Sgreccia,
  • Mohamad Abdalkader,
  • Nicola Limbucci,
  • Alessandro Pedicelli,
  • Francesco Capasso,
  • Francesco Arba,
  • Ludovica Migliaccio,
  • Mariangela Piano,
  • Maria Porzia Ganimede,
  • Emilio Lozupone,
  • Chiara Gaudino,
  • Francesca Ricchetti,
  • Riccardo Russo,
  • Julien Burel,
  • Francesco D’Argento,
  • Serena Abruzzese,
  • Julien Allard,
  • Nicolas Chausson,
  • Roberta Partesano,
  • Nicola Cavasin,
  • Nicolò Mandruzzato,
  • Joseph Domenico Gabrieli,
  • Pietro Trombatore,
  • Antonio Armando Caragliano,
  • Federico Mazzacane,
  • Giancarlo Salsano,
  • Antioco Sanna,
  • Pietro Panni,
  • Andrea Zini,
  • Frédéric Clarençon,
  • Eytan Raz,
  • Thanh Nguyen,
  • Aldobrando Broccolini

摘要

Purpose

Mechanical thrombectomy (MT) is standard care for acute large vessel occlusion (LVO), but it fails in 10–20% of cases, often due to underlying intracranial artery stenosis (ICAS). In such cases, rescue stenting (RS), with or without angioplasty, may improve recanalization, but its clinical benefit remains debated. The purpose of this study was to define predictors of clinical outcome in this patient population.

Methods

We conducted a retrospective multicenter study including 115 patients with ICAS-related occlusion of the middle cerebral artery (MCA) treated with MT and RS across 27 international stroke centers. Baseline, procedural, and post-procedural variables were analyzed. The outcome measure was the ordinal shift of the 90-day modified Rankin Scale (mRS) score. Stepwise multivariate regression and structural equation modeling (SEM) were used to identify outcome predictors and explore mediation pathways.

Results

Successful recanalization (modified Treatment in Cerebral Infarction (mTICI) score ≥ 2b) was achieved in 94.8% of patients, with 73.0% reaching mTICI 2c‑3. SEM showed that baseline Alberta Stroke Program Early CT Score (ASPECTS), stenting with angioplasty and achieving mTICI 2c‑3 were associated with improved functional outcome, mediated by higher post-procedural ASPECTS. Post-procedural ASPECTS influenced functional outcome both directly (estimate = −0.45, p < 0.001) and indirectly by reducing the occurrence of symptomatic intracranial hemorrhage (sICH) (estimate = −0.09, p = 0.004). This model explained 36.5% of the variance in 90-day mRS scores.

Conclusion

In patients with acute ICAS-related MCA occlusion, stenting with angioplasty and achieving mTICI 2c–3 recanalization are associated with improved clinical outcome. These benefits are mediated by better post-procedural ASPECTS and reduced sICH. Prospective studies are warranted to confirm these findings.