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Comparative Study
. 2025 Jun 1;17(e2):e295-e302.
doi: 10.1136/jnis-2024-022795.

Balloon-mounted versus self-expandable stent in failed neurothrombectomy: a post hoc analysis of the SAINT study

Mahmoud H Mohammaden  1   2   3 , Pedro N Martins  1   2 , Hassan Aboul-Nour  4 , Alhamza R Al-Bayati  5 , Ameer E Hassan  6 , Wondwossen Tekle  6 , Johanna T Fifi  7 , Shahram Majidi  7 , Okkes Kuybu  8 , Bradley A Gross  9 , Michael Lang  9 , Gustavo M Cortez  10 , Ricardo A Hanel  10 , Amin Aghaebrahim  10 , Eric Sauvageau  10 , Mohamed A Tarek  1   2 , Mudassir Farooqui  11 , Santiago Ortega-Gutierrez  11 , Cynthia B Zevallos  11 , Milagros Galecio-Castillo  11 , Sunil A Sheth  12 , Michael Nahhas  12 , Sergio Salazar-Marioni  12 , Thanh N Nguyen  13 , Mohamad Abdalkader  14 , Piers Klein  13 , Muhammad Hafeez  15 , Peter Kan  16 , Omar Tanweer  15 , Ahmad Khaldi  17 , Hanzhou Li  17 , Mouhammad Jumaa  18 , Syed F Zaidi  18 , Marion Oliver  18 , Mohamed M Salem  19 , Jan-Karl Burkhardt  19 , Bryan Pukenas  20 , Nicholas Vigilante  21 , Mary Penckofer  21 , James E Siegler  21 , Sophia Peng  22 , Ali Alaraj  22 , Jonathan A Grossberg  2   23 , Raul Nogueira  5 , Diogo C Haussen  24   2
Affiliations
Comparative Study

Balloon-mounted versus self-expandable stent in failed neurothrombectomy: a post hoc analysis of the SAINT study

Mahmoud H Mohammaden et al. J Neurointerv Surg. .

Abstract

Background: Previous studies have shown that when thrombectomy has failed, rescue intracranial stenting is associated with better clinical outcomes compared with failed reperfusion. However, comparative data regarding stent type are lacking.

Objective: To compare the procedural and clinical outcomes of balloon-mounted stents (BMS) with those of self-expandable stents (SES).

Methods: Retrospective analysis of a prospectively collected database from the Stenting and Angioplasty in NeuroThrombectomy (SAINT) consortium. Patients were included if thrombectomy had failed and they then underwent rescue emergency stenting. Patients treated with SES or BMS were compared using inverse probability of treatment weighting. The primary outcome was the final reperfusion as measured by the modified Thrombolysis in Cerebral Infarction (mTICI) Scale. Safety measures included rates of symptomatic intracranial hemorrhage, procedural complications, and 90-day mortality.

Results: A total of 328 patients were included. Baseline clinical and procedural characteristics were well balanced among both groups. The BMS group (n=127) had higher rates of successful reperfusion (94.5% vs 86.6%, aOR=4.23, 95% CI 1.57 to 11.37, P=0.004) and increased likelihood of higher degree of final reperfusion on the mTICI Scale (acOR=2.06, 95% CI 1.19 to 3.57, P=0.01) than the SES group (n=201). No difference in modified Rankin Scale shift (acOR=0.98, 95% CI 0.54 to 1.79, P=0.95), rates of mRS0-2 (26% vs 36%, aOR=0.93, 95% CI 0.46 to 1.88, P=0.83) and mRS0-3 (43% vs 50%, aOR=0.92, 95% CI 0.51 to 1.66, P=0.77) at 90 days were noted. Safety measures were comparable in both groups.

Conclusion: The present study demonstrates higher reperfusion rates with BMS than with SES in failed thrombectomy procedures that involved rescue stenting. No differences in hemorrhagic complications or clinical outcomes were noted. Further larger controlled studies are warranted.

Keywords: Angioplasty; Balloon; Stent; Thrombectomy.

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Conflict of interest statement

Competing interests: Competing Interests Statement MHM: no disclosure, DCH is a consultant for Stryker and Vesalio and holds stock options at Viz.AI. RGN reports consulting fees for advisory roles with Stryker Neurovascular, Cerenovus, Medtronic, Phenox, Anaconda, Genentech, Biogen, Prolong Pharmaceuticals, Imperative Care and stock options for advisory roles with Brainomix, Viz-AI, Corindus Vascular Robotics, Vesalio, Ceretrieve, Astrocyte and Cerebrotech. ARA is a consultant for Stryker Neurovascular. AEH - 1. Consultant/speaker: Medtronic, Microvention, Stryker, Penumbra, Cerenovus, Genentech, GE Healthcare, Scientia, Balt, Viz.ai, Insera therapeutics, Proximie, NovaSignal and Vesalio. 2.Principal investigator: COMPLETE study Penumbra, LVO SYNCHRONISE-Viz.ai. 3.Steering committee/publication committee member: SELECT, DAWN, SELECT 2, EXPEDITE II, EMBOLISE, CLEAR. 4.Proctor: Pipeline, FRED, Wingspan, and Onyx. 5.Supported by grants from: GE Healthcare. JTF is a consultant Cerenovus, Stryker, Medtronic, Siemens, Microvention, MIVI. Stockholder in Imperative Care. TNN: advisory board Brainomix, Aruna Bio; Associate Editor of Stroke; speaker for Genentech, Kaneka. SOG: Grants-NIH-NINDS (R01NS127114-01, RO3NS126804-01), Stryker, Medtronic, Microvention, Methinks, Viz.ai. Consulting fees: Medtronic, Stryker Neurovascular. AA is consultant for Cerenovus. JB is a consultant for Q'pel Medical, Medtronic, Microvention, Stryker, Cerenovous, Balt, and Siemens Healthineers. RAH: is a consultant for Medtronic, Stryker, Cerenovus, Microvention, Balt, Phenox, Rapid Medical, and Q'Apel, advisory board for MiVI, eLum, Three Rivers, Shape Medical and Corindus. Unrestricted research grant from NIH, Interline Endowment, Microvention, Stryker, CNX. Investor/stockholder for InNeuroCo, Cerebrotech, eLum, Endostream, Three Rivers Medical Inc, Scientia, RisT, BlinkTBI, and Corindus. AA: is on advisory board for iSchema View. JES reports consulting fees from AstraZeneca, and research support from Medtronic and Philips (all unrelated to the present work). The other authors report no conflicts.

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