Mid-term outcome of first stenting without retrieval technique for acute intracranial atherosclerotic stenosis related large vessel occlusion in anterior circulation.

BACKGROUND

This study aims to evaluate the mid-term angiographic and clinical outcomes of the first stenting without retrieval (FRESH) technique in the management of intracranial atherosclerotic disease (ICAD)-related anterior circulation large vessel occlusion (LVO).

METHODS

We retrospectively analyzed the data of 50 patients who underwent the FRESH technique between 2019 and 2024. Clinical characteristics, procedural outcomes, angiographic follow-up findings on digital subtraction angiography (DSA), and functional outcomes were assessed. Vessel diameter and residual stenosis were measured immediately after stenting and at 1 week, 3 months, and 1 year. The primary outcomes were successful recanalization (mTICI ≥ 2b) and favorable functional outcome (modified Rankin Scale, 0-2).

RESULTS

All patients (100%) achieved successful reperfusion, with no cases of symptomatic intracranial hemorrhage. Favorable functional outcomes were observed in 88% of patients at 3 months (44/50) and were maintained at ≥ 12 months (88%, 42/48). Stroke recurrence occurred in two patients (4%). Serial DSA showed progressive vessel remodeling, with the median stented vessel diameter increasing from 0.7 mm immediately post-stenting to 1.5 mm at 1 week, 1.61 mm at 3 months, and 1.53 mm at 1 year (P = 0.003). Residual stenosis decreased from 73.1% immediately post-stenting to 43.0% at 1 week, 38.8% at 3 months, and 45.9% at 1 year. Four patients experienced re-occlusion, two of whom required repeat stenting; none experienced adverse functional outcomes.

CONCLUSION

The FRESH technique for ICAD-related anterior circulation LVO demonstrated durable vessel patency, sustained favorable clinical outcomes, and a low complication rate at mid-term follow-up.