Experience With Neuroform Atlas Stenting as Rescue Endovascular Treatment After Failed Mechanical Thrombectomy Secondary to Intracranial Atherosclerosis

Background Patients with emergent large vessel occlusion secondary to intracranial atherosclerotic stenosis who fail mechanical thrombectomy pose a treatment challenge. The aim of this study is to report our single‐center experience using the Neuroform Atlas stent as a potential rescue modality. Methods Data were analyzed from a prospectively maintained database at a Comprehensive Stroke Center between January 2019 and September 2021 of all patients with intracranial atherosclerotic stenosis–emergent large vessel occlusion who underwent mechanical thrombectomy and required rescue stenting with the Neuroform Atlas. We systematically gathered demographic, clinical, procedural, and functional characteristics on patients presenting with emergent large vessel occlusion within 24 hours of last known normal. The primary outcome was the rate of revascularization following stenting. Results Twenty‐six patients met the inclusion criteria, with a mean age of 56.5 years, 34.6% of whom were women. On presentation, the median National Institutes of Health Stroke Scale was 11 and median Alberta Stroke Program Early Computed Tomography Score was 9. Mechanical thrombectomy was performed using a direct aspiration, first‐pass technique in all patients. Following Neuroform Atlas stent placement, 3 patients (11.5%) had moderate in‐stent stenosis, while severe stenosis was encountered in 4 patients (15.4%). The rate of successful revascularization (Thrombolysis in Cerebral Infarction 2B–3) was identified in 92.3% of the patients. On follow‐up vascular images, reocclusion occurred in 2 patients (7.7%) and symptomatic hemorrhage was encountered in 3 patients (11.5%). Excellent outcome at 90 days (modified Rankin scale 0–2) was achieved in 13 of 26 (50%) patients. Conclusion Our series provides preliminary safety and efficacy data regarding the use of the Neuroform Atlas stent as a rescue modality in intracranial atherosclerotic stenosis–emergent large vessel occlusion cases.