Rescue stenting for failed basilar artery thrombectomy in acute stroke

The study led by Shuai Yu, in this issue of EuroIntervention, is a valuable contribution to the evolving field of stroke intervention, particularly in the context of rescue intracranial stenting (RIS) for basilar artery occlusion. This paper demonstrates the feasibility and safety of RIS despite its clinical outcomes not showing improvement, which may well be due to the inherent complexities and limitations of the study design and patient cohort1.

One of the primary challenges in treating basilar artery occlusion lies in the variable clinical presentations, with patients displaying mild, moderate or severe stroke symptoms leading to a wide range of National Institutes of Health Stroke Scale (NIHSS) scores.

This stroke type is also notorious for its difficulty in establishing an exact time of onset, as posterior circulation strokes frequently present with stuttering symptoms, sometimes spanning days before the actual diagnosis. These nuances complicate the accurate assessment of RIS effectiveness due the variability in recorded severity and stroke onset-to-recanalisation time.

Additionally, the anatomy of the posterior circulation is highly variable, and the outcome of endovascular interventions depends heavily on the collateral circulation and...