Rescue Stenting in Mechanical Thrombectomy Refractory Occlusions: A Single Center Multiethnic Cohort

Introduction Refractory large vessel occlusion in acute ischemic stroke carries high morbidity and mortality. Rescue stenting is an emerging modality that is increasingly utilized especially in East Asia. We aim to investigate the safety and efficacy of performing rescue stenting in acute stroke patients who had failed mechanical thrombectomy. Methods This is a retrospective, all-inclusive, observational, descriptive review of the prospectively collected stroke database. Post stenting, an aggressive antiplatelet protocol was followed with glycoprotein IIb/IIIa infusion. Incidence of intracerebral hemorrhage (ICH), recanalization score and favorable prognosis (modified Rankin Score ≤3) at 90 days was used to determine primary outcome. Additionally, comparison was made between patients from the Middle East and North Africa (MENA) region and others. Results In total, 55 patients were included with 87.3% being male. Mean age was 51.3±11.8 years. This included 32 patients (58.3%) from South Asia, 12 (21.8%) from the MENA region, 9 (16.4%) from Southeast Asia and 2 (3.6%) from other parts of the world. Optimal recanalization (Thrombolysis in cerebral infarction (TICI) scale=2b-3) was achieved in 43 (78.2%); the incidence of symptomatic ICH was 2 (3.6%) and favorable outcome at 90 days was seen in 23 (41.8%). Apart from significantly older age, mean 62.8±13 years (median 69) vs. 48.1±9.3 (mean 49) and coronary artery disease burden 4 (33.3%) vs.1 (2.3%) (p<0.05). Patients from the MENA cohort had similar risk factor profiles, stroke severity, recanalization rates, ICH rates and 90-day outcomes compared to patients from South and Southeast Asia. Conclusion Rescue stenting showed comparably good outcomes and low risk of clinically significant bleeding in a multiethnic cohort of patients from MENA and South and Southeast Asia. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Hamad Medical Corporation gave ethical approval for this work Medical Research Center Protocol MRC-01-20-071. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors