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Advanced Neurology

REVIEW ARTICLE
Rescue stenting in refractory mechanical

thrombectomy: A review

Noor A. Mahmoud 1 , Mohamad Abdalkader 2 , Sami Al Kasab 3 ,
5
Adam de Havenon 4 , Xu Tong , Baixue Jia 5 , Piers Klein 2 , Marios Psychogios 6 ,
Urs Fischer 7 , Zhongrong Miao 5 , and Thanh N. Nguyen *
2
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
(This article belongs to the Special Issue: Advances in stroke research and therapy)

Abstract

Despite advancements in mechanical thrombectomy (MT) in the treatment of large
vessel occlusions, failure to achieve recanalization remains a challenge in 10 – 30%
*Corresponding author: of patients. Several underlying pathologies have been postulated in refractory MT,
Thanh N. Nguyen
(thanh.nguyen@bmc.org) including intracranial atherosclerotic stenosis, intracranial dissection, and recalcitrant
emboli. Rescue strategies to maximize recanalization rates, such as alternative access
Citation: Mahmoud NA, routes, local thrombolysis, stent-assisted angioplasty, and acute “rescue” stenting,
Abdalkader M, Al Kasab S, et al.
Rescue stenting in refractory have been proposed. Considered an emerging treatment strategy for refractory MT,
mechanical thrombectomy: A rescue stenting (RS) has been shown in non-randomized observational studies as a safe
review. Adv Neuro. 2024;3(3):3950. and effective strategy for increasing reperfusion rates and consequently improving
doi: 10.36922/an.3950
clinical outcomes. The effective use of RS approach requires consideration of patient-
Received: June 15, 2024 specific characteristics, clot characteristics, and lesion anatomy. This review provides
Accepted: August 15, 2024 an overview of the understanding of refractory MT, epidemiology, pathophysiology,
current evidence supporting RS in the anterior and posterior circulation, stents used,
Published Online: September 10, 2024 endovascular techniques, patient selection criteria, antithrombotic use, risks, and
Copyright: © 2024 Author(s). complications.
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution Keywords: Rescue stenting; Mechanical thrombectomy; Recanalization; Large
License, permitting distribution, vessel occlusion
and reproduction in any medium,
provided the original work is
properly cited.
Publisher’s Note: AccScience
Publishing remains neutral with 1. Introduction
regard to jurisdictional claims in
published maps and institutional Stroke constitutes a significant global health burden and is a leading contributor to
affiliations. death and disability. Stroke mortality is expected to rise from 6.6 million in 2020 to

Volume 3 Issue 3 (2024) 1 doi: 10.36922/an.3950