Single-center outcomes of Onyx Frontier? and Resolute Onyx? drug-eluting balloon-mounted stents for rescue stenting for acute large vessel occlusion

Background: In cases where mechanical thrombectomy (MT) fails, rescue stenting may be necessary to achieve reperfusion; however, the lack of standardized techniques or devices poses a challenge. This series aims to present our early experience with the Onyx Frontier (TM) and Resolute Onyx (TM) balloon-mounted drug-eluting stents for rescue stenting. Methods: A retrospective chart review was performed of all patients who underwent rescue stenting, in the setting of failed MT, using Onyx Frontier (TM) or Resolute Onyx (TM) stents at a single institution. Technical details, procedural complications, and patient outcomes were recorded for each case. Results: Twenty-two Onyx Frontier (TM) and Resolute Onyx (TM) stents were deployed in 18 patients undergoing rescue stenting. Stent locations included the middle cerebral artery (36.4%), internal carotid artery (18.2%), vertebral artery (22.7%), and basilar artery (22.7%). The average National Institutes of Health Stroke Scale score before MT was 13.8 (range 0-31). The median initial modified Rankin Scale (mRS) score was zero, while the median mRS score at follow-up was three. Successful reperfusion, as assessed by TICI scores, was achieved in 43.8% of patients for TICI 3, 43.8% for TICI 2C, and 12.5% for TICI 2B. Post-revascularization, 16.7% of patients experienced hemorrhage, of which one patient (5.6%) had symptomatic hemorrhage. Conclusions: Onyx Frontier (TM) and Resolute Onyx (TM) stents are well suited for rescue stenting in cases of failed MT. These balloon-mounted drug-eluting stents exhibit excellent navigability, rendering them appropriate for rescue revascularization procedures. Our findings demonstrate that these stents confer a high degree of technical success.