ABSTRACT NUMBER: ESOC2026A1237 EFFICACY AND SAFETY OF EMERGENT CAROTID STENTING IN PATIENTS WITH ACUTE ISCHEMIC STROKE DUE TO ISOLATED EXTRACRANIAL CAROTID ARTERY OCCLUSION

Abstract Background and aims Emergent carotid artery stenting (eCAS) in acute ischemic stroke due to tandem occlusion (TO) is an increasingly widespread treatment. However, its use in cases of isolated extracranial internal carotid artery occlusion (IE-ICAO) has been less studied. We compared the outcomes of eCAS in IE-ICAO and TO patients. Methods We conducted a multicenter registry of ischemic stroke patients treated with eCAS between 2019 and 2023. Demographics, stroke characteristics, treatment, complications, and 3-month modified Rankin Scale (mRS) score were collected. Main outcome measures were early stent occlusion (<48 hours), symptomatic intracerebral haemorrhage (sICH), late stent restenosis/occlusion, and good functional outcome (mRS 0–2) at 3 months. Comparative analysis was performed between IE-ICAO and TO patients. Results A total of 309 patients were included (69.6% male, mean age 67.1). Median baseline NIHSS was 16 (IQR 9–20) and ASPECTS was 9 (7–10). 35 patients (11.4%) had IE-ICAO. Early stent occlusion occurred in 9 patients (3.1%), with no differences between IE-ICAO and TO (3.1% vs 3.2%; p=0.991). No significant differences were observed in sICH (2.9% vs 6.3%, p=0.437). With a median follow-up of 90 days, 27 late stent restenosis/occlusions (13%) were identified, 23% in IE-ICAO vs 11.5% in TO (p=0.102). Functional recovery at 3 months was similar (60.7% vs 53.8%; p=0.480; adjusted OR 1.12 [0.45–2.81], p=0.805). Conclusions In this study, eCAS in patients with IE-ICAO showed comparable efficacy and safety to that observed in patients with TO, although a trend towards higher rates of late stent restenosis/occlusion was noted. Conflict of interest Rebeca Boto: nothing to disclose