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Mozafari P, Tsiklauri T, Lobzhanidze S, Bakuridze G, Anakidze A, Bagheri M H. Beyond Thrombectomy: A Comprehensive Narrative Review of Rescue Angioplasty and Stenting in Refractory Large-Vessel Occlusion Stroke. Neuroscience Updates 2025; 3 (1) :62-75
URL: http://neuroupdates.de/article-1-127-en.html
Beyond Thrombectomy: A Comprehensive Narrative Review of Rescue Angioplasty and Stenting in Refractory Large-Vessel Occlusion Stroke
Parvin Mozafari1 , Tatia Tsiklauri2 , Salome Lobzhanidze2 , Giorgi Bakuridze2 , Ana Anakidze *3 , Mohammad Hassan Bagheri4
1- Faculty of Medicine, University of Georgia, Tbilisi, Georgia.
2- Tbilisi State Medical University, Tbilisi, Georgia
3- David Tvildiani Medical University, Tbilisi, Georgia
4- Tehran University of Medical Sciences, Tehran, Iran
Abstract:   (85 Views)

Acute ischemic stroke (AIS) due to large vessel occlusion (LVO) has continued to be a significant cause of mortality and disability worldwide. The standard treatment is mechanical thrombectomy (MT); still, the failure of recanalization can take place in 25-30 percent of the cases, frequently because of intracranial atherosclerotic disease (ICAD) underlying the thrombectomy. Possible interventions such as rescue angioplasty and stenting have appeared to be potential interventions on refractory LVO after unsuccessful MT. A qualitative synthesis was performed on 25 studies that have been published since January 2018 and up to May 2025 to evaluate their efficacy and safety. ICAD was mainly associated with failed MT, and secondary causes were embolic occlusions and sub adventitial dissection. Rescue angioplasty and stenting had a higher recanalization success (80-90) and had better functional outcomes at 90days (modified Rankin Scale 0-2 in 34.6-68.4% of patients) than medical therapy alone did. Symptomatic intracranial hemorrhage and stent thrombosis were the main safety issues, and their prevalence was dependent on the method of the procedure and antithrombotic treatment. The strategies of decision making were based on the consideration of the cause of failed MT and subsequent intervention based on it. Future research to determine the role of rescue angioplasty and stenting in the management of refractory LVO stroke should focus on standardizing patient selection, optimizing peri and post procedural pharmacotherapy, and randomized controlled trials.

Keywords: Acute ischemic stroke, Intravenous thrombolysis, Mechanical thrombectomy, large vessel occlusion, Intracranial hemorrhage
     
Type of Study: Review Article | Subject: Neurodegenerative Disease
Received: 2025/06/18 | Accepted: 2025/08/5 | Published: 2025/08/10
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