Abstract
Background
Large vessel occlusion (LVO) due to intracranial atherosclerotic stenosis (ICAS) often leads to failed or unstable reperfusion after mechanical thrombectomy (MT). Rescue intracranial stent placement is increasingly used, but its benefit-to-risk profile remains unclear. Prior systematic reviews have frequently pooled different rescue strategies and heterogeneous cohorts, limiting inference on the independent risk-benefit profile of stent placement in ICAS-LVO.Purpose
To quantify the efficacy and safety of rescue stent placement in ICAS-LVO.Data sources
Comparative studies evaluating permanent rescue stent placement for ICAS-LVO during MT from January 1, 2020, through October 31, 2025, were searched in PubMed, EMBASE, Scopus, and the Web of Science.Study selection
Eight comparative studies encompassing 1901 patients with confirmed LVO due to intracranial atherosclerotic stenosis (654 treated with rescue stent placement and 1247 managed with a no-stent strategy) were included.Data analysis
We evaluated 90-day functional independence (mRS 0-2), successful reperfusion (TICI ≥ 2b), symptomatic intracranial hemorrhage, and mortality; when available, we also extracted data by stent type. Meta-analysis was performed using a random-effects model.Data synthesis
Eight studies (1901 patients; 654 stented, 1247 controls) were included. Rescue stent placement was associated with higher odds of 90-day functional independence (mRS 0-2) (OR, 1.61; 95% CI, 1.13-2.29) and successful reperfusion (TICI ≥ 2b) (OR, 2.47; 95% CI, 1.55-3.93). Mortality was not significantly different (OR, 0.74; 95% CI, 0.45-1.22), and symptomatic intracranial hemorrhage was not significantly increased (OR, 1.25; 95% CI, 0.81-1.95). In stent-type subgroup analyses, no apparent differences were observed between self-expanding and balloon-mounted stents for functional or safety outcomes.Limitations
Evidence is limited by the small number of included studies and their observational nature, with potential confounding by indication and selection bias; heterogeneity was moderate for the functional outcome and substantial for mortality; symptomatic hemorrhage definitions varied, and event counts were limited.Conclusions
In LVO due to intracranial atherosclerotic stenosis, rescue stent placement is associated with higher reperfusion rates and improved 90-day functional outcomes without a statistically significant increase in symptomatic hemorrhage, whereas any mortality benefit remains uncertain. The certainty of the evidence is low, and randomized data are needed to confirm causality and optimize patient selection.