Endovascular Treatment in Patients With Acute Ischemic Stroke and Intracranial Stenting: A Cohort Study of EVA-TRISP Collaboration

Introduction

Ischemic stroke is a major global cause of disability and death. Although clot-removing endovascular treatment (EVT) is the standard treatment for large vessel occlusion, the additional benefit of permanent intracranial stenting during EVT remains uncertain. This study is aimed at comparing outcomes between patients treated with EVT alone and those who also received a permanent stent, focusing on a predominantly Caucasian population.

Patients and methods

We analyzed data from 14,435 stroke patients treated with EVT across 16 comprehensive stroke centers in the EVA-TRISP collaboration. Among them, 386 patients received a permanent intracranial stent. Functional outcomes at 3 months and the occurrence of fatal and symptomatic intracerebral hemorrhage (ICH) were evaluated using ECASS II/III criteria.

Results

Stent placement was not initially associated with worse functional outcome in univariable analysis (OR 1.19, 95% CI 0.98–1.43). However, stent placement was associated with worse prognosis after adjusting for age, sex, comorbidities, and Prior IV thrombolysis (OR 1.36, 95% CI 1.13–1.67). There were no significant differences in symptomatic, fatal ICH or 3-month mortality between the groups.

Discussion

Patients treated with EVT alone had better functional recovery and less disability at 3 months. However, the reason for stenting was not documented for this cohort.

Conclusion

In this multicenter cohort, EVT alone was associated with better functional outcomes than EVT with stenting. Further randomized studies are needed to identify patients who may benefit from stenting.