ABSTRACT NUMBER: ESOC2026A693 RESCUE STENTING FOR FAILED MECHANICAL THROMBECTOMY IN ACUTE ISCHAEMIC STROKE

Abstract Background and aims Rescue intracranial stenting (RIS) is employed for refractory large vessel occlusions following failed endovascular thrombectomy (EVT) in acute ischaemic stroke. Intracranial atherosclerotic disease (ICAD) underlies 40% of large vessel occlusions in Asian populations, yet evidence for rescue stenting remains limited. This study aimed to evaluate the efficacy and safety of RIS in our local population. Methods We conducted a retrospective study of consecutive patients who underwent RIS at our comprehensive stroke centre from 2021-2024. RIS was defined as stenting for refractory large vessel occlusion following EVT to maintain vessel permeability. Primary outcomes included successful recanalisation (TICI grade 2b-3), favourable functional outcome (mRS 0-2 at 3 months), and rate of symptomatic intracranial haemorrhage (sICH). Results Fifty-one patients underwent RIS (median age 62.5 years, 68.6% male, median NIHSS 16). Most occlusions involved the middle cerebral artery (74.5%). Thrombolysis was administered in 19.6% of cases. Periprocedural anticoagulation was used in 92.6% of patients. Successful recanalisation (TICI 2b-3) was achieved in 90.2% of cases. At 3 months, 49% achieved favourable outcomes (mRS 0-2), with 39.2% achieving excellent outcomes (mRS 0-1). Mortality was 15.7%. Any intracranial haemorrhage occurred in 41.2% of patients, with sICH in 9.8%. Notably, only one of ten patients receiving concurrent thrombolysis developed sICH. Conclusions RIS demonstrates high recanalisation rates and acceptable safety profiles in our cohort. The low sICH rate, even with concurrent thrombolysis, suggests RIS may be a viable rescue strategy for failed EVT in carefully selected patients. Conflict of interest Jonathan Lai: Nothing to disclose