ABSTRACT NUMBER: ESOC2026LB81 STENT-RETRIEVER–ASSISTED INTRA-ARTERIAL LYSIS FOR DISTAL VESSEL OCCLUSIONS: A FEASIBLE PHARMACOMECHANICAL RESCUE STRATEGY

Abstract Background and aims The role of endovascular treatment (EVT) for medium and distal vessel occlusions (MeVO) remains uncertain after recent randomized trials failed to show clinical benefit and raised safety concerns. Stent-retriever–assisted intra-arterial lysis (SAIL) is a pharmacomechanical technique designed to enable distal reperfusion while minimizing mechanical stress on fragile vessels. We evaluated feasibility, safety, and outcomes of SAIL in distal vessel occlusions. Methods We performed a retrospective single-center analysis of consecutive acute ischemic stroke patients with angiographically confirmed distal vessel occlusions treated with SAIL between March 2022 and January 2026. Occlusions involved M2–M3, A2–A3, or P1–P2 segments and were classified as primary or secondary. SAIL consisted of temporary stent retriever deployment across the thrombus to restore flow, combined with slow intra-arterial infusion of tirofiban or alteplase, followed by resheathing without traction. Primary outcomes were feasibility and safety, including symptomatic intracranial hemorrhage (sICH). Secondary outcomes included angiographic reperfusion and clinical outcomes at discharge and 90 days. Results Twenty-four patients were included (mean age 75.5 years; median baseline NIHSS 11). SAIL was used as rescue therapy after unsuccessful mechanical thrombectomy in 70.8%. Successful reperfusion (mTICI ≥2b) was achieved in 83.3%, with near-complete or complete reperfusion in 50.0%. Any intracranial hemorrhage occurred in 29.2%, while sICH occurred in one patient (4.2%). At 90 days, functional independence (mRS 0–2) was achieved in 52.4% of evaluable patients. Conclusions SAIL was feasible and associated with high distal reperfusion rates and low sICH. Findings support further prospective evaluation in selected distal vessel occlusions and clinical practice. Conflict of interest