Abstract WP035: Rescue Balloon Angioplasty or Stenting for Acute Large Vessel Occlusion Stroke with Residual Intracranial Atherosclerotic Stenosis

Background: The effect of rescue balloon angioplasty or stenting for acute large vessel occlusion (LVO) stroke with residual intracranial atherosclerotic stenosis (ICAS) following endovascular thrombectomy (EVT) remains uncertain. This multicenter retrospective study aimed to investigate whether rescue balloon angioplasty or stenting is beneficial in improving neurological recovery in LVO patients with residual ICAS following EVT. Methods: We retrospectively included patients with LVO who underwent EVT with residual ICAS >50% between January 1, 2020, and December 31, 2024 from six stroke centers in China. Eligible patients were divided into two groups: those who received rescue balloon angioplasty with or without stenting (rescue group) and those who received thrombectomy alone (control group). The primary outcome was functional independence at 90 days, defined by a score on the modified Rankin Scale (mRS) of 0 to 2. Safety outcomes included symptomatic intracranial hemorrhage, any intracranial hemorrhage, and 90-day mortality. Results: 292 patients were included in the study, with 186 patients in the rescue group and 106 in the control group. No statistically significant differences were observed between the rescue and control groups regarding the primary outcome (54.8% vs. 63.6%; adjusted OR: 0.92, 95% CI: 0.44–1.91; P=0.82). In safety outcomes, the proportion of any intracranial hemorrhage was numerically higher in the rescue group compared to the control group, although the difference was statistically non-significant after adjustment for confounding factors (19.7% vs. 5.5%; adjusted OR: 1.90, 95 CI%: 0.64-6.46; P=0.27). The 90-day mortality (6.4% vs. 3.6%; adjusted OR:1.21, 95CI%: 0.20-9.91; P=0.85) and symptomatic intracranial hemorrhage (3.2% vs. 1.8%; adjusted OR: 1.42, 95 CI%: 0.19-16.90; P=0.75) also showed no significant differences. Conclusion: Rescue balloon angioplasty and stenting should be applied with greater caution in patients with residual ICAS following LVO thrombectomy.