ABSTRACT NUMBER: ESOC2026A147 THROMBECTOMY WITH AND WITHOUT EMERGENT STENTING IN ACUTE ISCHEMIC STROKE DUE TO CAROTID ARTERY DISSECTION

Abstract Background and aims Whether thrombectomy with or without emergent carotid stenting improves outcomes in patients with large vessel occlusion (LVO) stroke due to carotid artery dissection (CAD) is unknown. Methods International multicenter observational study. Patients with LVO due to CAD undergoing thrombectomy with emergent stenting were compared to those without emergent stenting. The primary outcome was functional independence (modified Rankin Scale 0–2) at 3 months, secondary outcomes included early neurological improvement within 24–48 hours (ENI), successful recanalization, symptomatic intracerebral hemorrhage (sICH) and mortality at 3 months. Inverse probability of treatment weighting and multivariable Poisson regression was used to adjust for group imbalances and to estimate the effect size, respectively. Results Of 516 patients (mean age 53,8 years, 76% male) undergoing thrombectomy, 167 (32.4%) and 349 (67.6%) were treated with or without emergent carotid stenting, respectively. After robust adjustment, emergent stenting was not associated with functional independence (adjusted risk ratio (aRR) = 1.01, 95% confidence interval (CI) 0.89–1.15) or ENI (aRR = 1.07, 95% CI 0.95–1.21) but with successful recanalization (aRR = 1.29, 95% CI 1.10–1.50) and reduced mortality at 3 months (aRR = 0.39, 95% CI 0.15-0.99). Risk of sICH was equivalent (aRR = 1.01, 95% CI 0.95–1.06). Conclusions In patients with LVO secondary to CAD, emergent stenting during endovascular procedure appeared safe, increased odds of successful recanalization and reduced 3-month mortality rates. However, intraprocedural stenting was not associated with better functional outcome. Conflict of interest Kaindl Lisa: nothing to declare, Giannakakis Michail: nothing to declare, Deutschmann Hannes: nothing to declare, Fiehler Jens: nothing to declare, Fischer Urs: nothing to declare, Dobrocky Tomas: nothing to declare, Poli Sven: nothing to declare, Sykora Marek: nothing to declare.