Abstract A001: When To Rescue: Optimizing The Timing of Intracranial Rescue Procedure During Mechanical Thrombectomy for Large Vessel Occlusion Strokes - A Pooled Analysis of the SVIN Registry

Background: The optimal timing of intracranial angioplasty/stenting during mechanical thrombectomy (MT) for large vessel occlusion strokes (LVOS) remains uncertain. We aimed to determine whether the timing of rescue angioplasty/stenting impacts functional outcomes in LVOS patients undergoing MT. Methods: We conducted a pooled analysis of the Society of Vascular and Interventional Neurology Registry data from 2010 to 2023. Included patients had a pre-stroke modified Rankin Scale (mRS) ≤2, underwent MT for ICA or MCA-M1/M2 occlusions, and had available 90-day mRS data. Patients who achieved successful reperfusion after a single pass were excluded. Patients were divided into 4 groups: A) multiple passes without angioplasty/stenting regardless of the final recanalization, B) angioplasty/stenting during 1st or 2nd pass, C) angioplasty/stenting during 3rd or 4th pass, and D) angioplasty/stenting after 4th pass. The primary outcome was the shift in disability at 90-days, measured by mRS. Secondary outcomes included functional independence (90-day mRS0-2), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. All outcomes were adjusted for relevant confounders. Results: Of 9,238 patients, 1,673 met inclusion criteria; multiple passes without angioplasty/stenting (n=1,477), angioplasty/stenting during 1st or 2nd pass (n=112), angioplasty/stenting during 3rd or 4th pass (n=50), and angioplasty/stenting after 4th pass (n=34). Baseline characteristics are shown in the Table . In ordinal shift analysis, early angioplasty/stenting was associated with significantly better functional outcomes compared to no rescue (mRS shift; acOR1.79, 95%CI1.23-2.62, p=0.002, and 90-day mRS0-2; aOR2.06, 95%CI1.31-3.25, p=0.002). There was no difference between angioplasty/stenting during the 3rd or 4th pass (mRS shift; acOR1.14, 95%CI0.67-1.94, p=0.62 and 90-day mRS0-2; aOR1.23, 95%CI0.61-2.46, p=0.57) and multiple passes without angioplasty/stenting. Patients with late rescue after 4th pass have numerically lower rates of functional independence compared to no rescue (mRS shift; acOR1.01, 95%CI0.51-2.00, p=0.98 and 90-day mRS0-2; aOR0.65, 95%CI0.21-2.02, p=0.46) Figure 1 . No differences in mortality or sICH were observed across groups Figure 2. Conclusions: The current analysis suggests that early rescue angioplasty/stenting is associated with improved functional outcomes compared to no rescue or late intervention in LVOS patients undergoing MT. Large prospective studies are warranted.