Stent Angioplasty in Acute-Phase ICAD-LVO: A Retrospective Cohort Study on Long-Term Recurrence and Safety Outcomes

OBJECTIVE: The optimal treatment strategy of Intracranial atherosclerotic disease-related large vessel occlusion (ICAD-LVO) remains undetermined. Current evaluation criteria focus on 90-day functional independence for acute-phase management, yet this timeframe does not represent the therapeutic endpoint given the persistent risk of recurrent stroke in this patient population. This study aims to examine whether stent angioplasty in patients with ICAD-LVO reduces long-term stroke recurrence risk while achieving successful vascular recanalization. METHODS: In this retrospective cohort study of 131 ICAD-LVO patients (June 2022-January 2024), 65 underwent emergency stenting and 66 received nonstenting therapy. The primary outcome was 30-day to 1-year stroke recurrence, analyzed using competing risks regression (Fine-Gray model). Secondary outcomes included safety and 90-day functional status. RESULTS: The 1-year cumulative incidence of recurrence was 4.9% in the stent group versus 13.7% in the nonstent group (Gray's test, P = 0.088). After adjustment, stenting was significantly associated with a lower recurrence risk (subdistribution hazard ratio 0.19, 95% confidence interval 0.04-0.82; P = 0.026). A history of stroke/transient ischemic attack predicted higher risk (subdistribution hazard ratio 8.81, P = 0.002). Stenting was not associated with increased symptomatic intracranial hemorrhage, parenchymal hematoma type 2, 90-day mortality, or differences in 90-day functional independence. CONCLUSIONS: In this retrospective cohort study, emergency stent angioplasty was associated with a lower risk of 30-day to 1-year stroke recurrence in intracranial atherosclerotic occlusions and was not associated with an increased risk of procedural complications.