P017 Intracranial dotter angioplasty using tenzing 7 for symptomatic atherosclerotic stenosis: initial multicenter experience

<h3>Introduction</h3> Traditional endovascular treatment of intracranial atherosclerotic disease (ICAD) includes balloon angioplasty and stenting. Catheter-mediated (‘Dotter’) angioplasty has been previously described for extracranial arteries. The Tenzing 7 (Route 92 Medical, San Mateo, CA) shelf-reducing delivery catheter has an atraumatic tapered distal tip that progressively enlarges to a 0.062 inch (1.6 mm) outer diameter (figure 1). <h3>Aim of Study</h3> We report our initial multicenter experience in treating symptomatic ICAD steno-occlusive lesions using Dotter angioplasty/Tenzing-plasty. <h3>Methods</h3> After local IRB approvals, we retrospectively reviewed consecutive patients undergoing endovascular treatment for symptomatic ICAD with off-label Tenzing-plasty, as a first approach at our stroke centers from 2021-2024. Subsequent adjunctive balloon angioplasty and/or stenting were performed at operator discretion. <h3>Results</h3> Twenty-eight consecutive underwent Tenzing-plasty, either as part of an emergent large vessel occlusion mechanical thrombectomy procedure, or if medical management of ICAD had previously failed. Median age was 63±12 years and 13 were female (46%). Stenosis location was: 12 M1, 7 M2, 2 ICA, 6 vertebral V4 segment, 1 basilar. The average pre-treatment ICAD stenosis was 95±7%, including 13/28(46%) with complete occlusion on initial angiogram. In 28/28(100%), Tenzing-plasty resulted in improvement in arterial caliber after median 1 pass (IQR 1-1), with average stenosis improving to 64±15%. Subsequent balloon angioplasty was performed in 5/28(18%). Stenting was performed in 12/28(43%) cases using a variety of self-expading or balloon-mounted stents. There were no instances of arterial perforation or symptomatic intracranial hemorrhage. <h3>Conclusion</h3> Tenzing-plasty is a feasible and safe alternative technique for improving luminal caliber and flow restoration for symptomatic ICAD lesions. Further study is warranted. <h3>Disclosure of Interest</h3> yes Consultant: Route 92 Medical, Stryker Research grants: Stryker, Microvention Equity interest: Route 92 Medical.