ABSTRACT NUMBER: ESOC2026A819 EARLY STENTING FOR INTRACRANIAL VERTEBROBASILAR DISSECTION RELATED ISCHEMIC STROKE AT HIGH RISK OF PROGRESSION: SAFETY AND OUTCOMES

Abstract Background and aims Intracranial vertebrobasilar dissection associated ischemic stroke (iVBDIS) carries a substantial risk of early stroke progression, and the role of stenting in unruptured iVBDIS remains underexplored. We evaluated the clinical characteristics, timing, and functional outcomes of early stenting for iVBDIS at a tertiary center over a 10-year period. Methods Patients with iVBDIS who underwent endovascular stenting within 1 month of stroke onset were retrospectively identified. Stenting was considered, but not mandated, when one or more of the following clinical or imaging features were present: basilar artery (BA) involvement, clinical progression despite medical therapy, bilateral high-grade vertebral artery (VA) stenosis, or radiographic progression of dissection. Outcomes were compared between patients receiving prophylactic stenting and those receiving stenting after stroke progression. Results Twenty patients (median age 65[range, 36–84]; 75% male) were included, 18 fulfilled at least one stenting consideration, while two underwent stenting based on individualized judgment. Twelve patients received stenting after clinical progression and eight prophylactically, with a median time to stenting of 11 [6.3–48.8] days and 10 [4–24.5] days, respectively. All underwent VA stenting, with 15 extending into BA. One peri-procedural stroke occurred. At 3 months, 50% achieved mRS 0–2, with prophylactic stenting associated with better outcomes (mRS 1 [1-2] vs. 3 [2-5], p=0.039). No recurrent strokes occurred during a median 29-month follow-up. Conclusions In carefully selected patients with iVBDIS, early stenting appears safe and may improve outcomes, particularly performed prophylactically before clinical deterioration. Conflict of interest no disclosure