ABSTRACT NUMBER: ESOC2026A1421 EMERGENT INTRACRANIAL STENTING DURING MECHANICAL THROMBECTOMY FOR ACUTE ISCHEMIC STROKE: CLINICAL AND RADIOLOGICAL OUTCOMES

Abstract Background and aims Underlying intracranial stenosis is a primary cause of failed mechanical thrombectomy (MT) in large-vessel occlusion strokes. Emergent stenting may be utilized as an adjunct to achieve or maintain reperfusion, although its safety and efficacy profiles are not yet fully established. Methods We analyzed consecutive patients undergoing emergent intracranial stenting during MT. Data collection included baseline demographics, clinical parameters (NIHSS, mRS, treatment timing, IV thrombolysis), and neuroradiological outcomes (occlusion site, intracranial hemorrhage [ICH], and recanalization grade). Results Twenty-four patients were included (45.8% anterior circulation). Successful recanalization was achieved in 91.7% of cases. A good clinical outcome (mRS 0–2 at discharge) was observed in 91.7% of patients, while ICH occurred in 40%. Twenty-five percent were wake-up strokes, while the remainder were treated within 6 hours of onset. Repeated measures ANOVA showed a significant improvement in NIHSS scores post-treatment (p=0.002). Chi-square analysis revealed a higher mortality rate in wake-up stroke patients compared to those treated within the 6-hour window (p=0.02). This finding was confirmed by binary logistic regression (p=0.03), even after adjusting for stroke severity and baseline mRS. Conclusions Emergent intracranial stenting appears to be a technically effective rescue strategy, achieving high recanalization rates. These findings highlight the importance of refined patient selection and the need for further research to clarify the role of this adjunct treatment across different clinical scenarios. Conflict of interest Valentina Oppo: nothing to disclose.