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. 2025 Nov 14:17474930251400088.
doi: 10.1177/17474930251400088. Online ahead of print.

Safety and efficacy of intravenous thrombolytics among patients with emergent intracranial stenting after thrombectomy: Subanalysis of the RESISTANT registry

Adnan Mujanovic  1 , Marta Olivé-Gadea  2 , Francesco Diana  3 , Greta Charlotte Sökeland  4 , David J Seiffge  4 , Serdar Geyik  5 , Songul Senadim  6 , Amedeo Cervo  7 , Andrea Salcuni  7 , Mariangela Piano  7 , Manuel Moreu  8 , Alfonso López-Frías  8 , Ameer E Hassan  9 , Samantha Miller  9 , Elena Zapata  10 , Asier de Albóniga-Chindurza  10 , Mauro Bergui  11 , Stefano Molinaro  11 , João André Sousa  12 , Fábio Gomes  12 , João Sargento  12 , Andrea Alexandre  13 , Alessandro Pedicelli  13 , Jeremy Hofmeister  14 , Paolo Machi  14 , Luca Scarcia  15 , Erwah Kalsoum  15 , Fabiano Cavalcante  16 , Fouzi Bala  17 , Jose Amorim  18 , Torcato Meira  18 , Santiago Ortega-Gutierrez  19 , Aaron Rodriguez-Calienes  19 , Leonardo Renieri  20 , Francesco Capasso  20 , Daniele G Romano  21 , Eduardo Barcena  22 , David Seoane  23 , Mohamad Abdalkader  24 , Piers Klein  25 , Thanh N Nguyen  25 , Catarina Perry-da-Câmara  26 , Isabel Fragata  26 , Dileep Yavagal  27 , Jude Hassan Charles  27 , José Rodríguez  28 , Pedro Vega  28 , Atilla Özcan Özdemir  29 , Zehra Uysal Kocabas  29 , Stanislas Smajda  30 , Sadiq Al Salman  30 , Jane Khalife  31 , Tudor Jovin  31 , Francesco Biraschi  32 , Francesca Ricchetti  32 , Pedro Castro  33 , Luis Albuquerque  34 , Adnan Siddiqui  35 , Vinay Jaikumar  35 , Pedro Navia  36 , Nikolaos Ntoulias  37 , Marios Psychogios  37 , Mariano Velo  38 , Joaquín Zamarro  39 , Gonzalo de Paco  39 , Osama Zaidat  40 , Yazan Ashouri  40 , Mohammad AlMajali  40 , Juan F Arenillas  41 , Alicia Sierra  41 , Michele Romoli  42 , João Pedro de Seabra Marto  43 , Shadi Yaghi  44 , Tomas Dobrocky  1 , Jan Gralla  1 , Urs Fischer  4 , Marc Ribo  2 , Alejandro Tomasello  3 , Manuel Requena  2   3   45 , Johannes Kaesmacher  1   17   46
Affiliations

Safety and efficacy of intravenous thrombolytics among patients with emergent intracranial stenting after thrombectomy: Subanalysis of the RESISTANT registry

Adnan Mujanovic et al. Int J Stroke. .

Abstract

Background: The value of intravenous thrombolysis (IVT) prior to endovascular therapy (EVT) with emergent stenting for intracranial atherosclerotic disease (ICAD)-large vessel occlusion (LVO) is unknown. We aimed to investigate the safety and efficacy of IVT among patients with adjuvant intracranial stenting after EVT.

Methods: RESISTANT is a study of consecutive acute ischemic stroke patients who underwent EVT and intracranial stenting from 36 comprehensive stroke centers in 7 countries across 3 continents. The primary outcome of interest was ordinal shift of the modified Rankin Scale (mRS) score at 90 days after the intervention. Secondary outcomes were excellent outcome (mRS 0-1) and functional independence (mRS 0-2) at 90 days. Safety outcomes were rates of symptomatic intracranial hemorrhage (sICH) at 24-hour and 90-day mortality. Adjusted multivariate ordinal and logistic regressions were performed for all outcomes.

Results: Of 828 patients (median age 67 years, interquartile range (IQR) 59-77; 65% male), 23% have received IVT. In the adjusted analysis, receiving IVT was not associated with mRS ordinal shift (aOR 0.8, 95% CI 0.6 -1.1), nor with functional independence (aOR 1.1, 95% 0.7-1.7). However, there was a positive association with excellent outcome (aOR 1.6, 95% CI 1.0-2.7). There were no differences in sICH rates at 24-h (aOR 1.5, 95% CI 0.8-2.9), nor 90-day mortality (aOR 0.8, 95% 0.5-1.3).

Conclusion: In this multi-center study of patients who underwent EVT with emergent intracranial stenting, IVT was associated with excellent clinical outcome, possibly due to indication bias, and there were no safety concerns. Receiving IVT should not be a criterion for deferring acute stenting among patients with ICAD-associated LVO and IVT should not be routinely withheld in suspected ICAD cases.

Keywords: ICAD; emergent stenting; intravenous thrombolysis.

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