ABSTRACT NUMBER: ESOC2026A646 DRUG-ELUTING VERSUS BARE-METAL BALLOON-MOUNTED STENT FOR ACUTE INTRACRANIAL STENTINGS: INSIGHTS FROM THE RESISTANT REGISTRY

Abstract Background and aims Rescue intracranial stenting is increasingly used in patients with large vessel occlusion (LVO) when reperfusion fails or when severe stenosis is present. This study aimed to evaluate the influence of drug-eluting technology on clinical and radiological outcomes from the RESISTANT registry. Methods The RESISTANT registry is a multicenter and international which includes patients who underwent intracranial stenting during endovascular treatment for acute ischemic stroke (2016–2023). The primary endpoint was good functional outcome at 90 days (mRS 0–2). Secondary endpoints included successful reperfusion (eTICI 2b–3), 24-hour stent patency, complications, and in-hospital mortality. Outcomes were compared between drug-eluting (DE) and bare-metal (BM) balloon-mounted stents. Results Among the balloon-mounted stents, 97 (55.1%) were DE and 79 (44.9%) were BM. Baseline clinical and radiological characteristics were similar between groups. During the procedure, the number of thrombectomy attempts (1.0 (0.0-2.0) vs 2.0 (1.0-3.0), p=0.008) were lower in BM group. Moreover, pre-stenting successful recanalization was higher in BM group (56.6% vs 31.5%, p=0.004). Finally, procedural antiplatelet treatment differed between groups with a higher rate of double antiplatelet therapy in DE group (BM 35.4% vs DE 68.0%, p<0.001). No differences were found at procedural or 90 days clinical outcomes. Symptomatic intracranial hemorrhage was more frequent in DE group (13.4% vs 3.1%, p=0.026) without a significant association (aOR (95%CI) 2.446 (0.214 - 27.989); p=0.472). Conclusions In our cohort, the use of DE technology was not a predictor of clinical outcome. Symptomatic intracranial hemorrhage was more frequent in DE group probably related to a more aggressive antiplatelet strategy. Conflict of interest All authors: nothing to disclose.