ABSTRACT NUMBER: ESOC2026A2400 RESCUE THROMBECTOMY STRATEGIES AND NIMBUS STENT-RETRIEVER USE IN REFRACTORY LARGE VESSEL OCCLUSION: A MULTICENTRIC ANALYSIS

Abstract Background and aims Recanalisation failure after multiple thrombectomy attempts remains a major limitation of endovascular stroke treatment. Optimal rescue strategies for refractory occlusions are not well established. Methods We performed a retrospective observational study of patients undergoing MT for AIS at two tertiary centers. Refractory occlusion was defined as failure to achieve successful recanalisation after three attempts. Rescue strategies were classified as no technique change, switch to a non-Nimbus stent retriever, or switch to Nimbus. Angiographic outcomes were assessed after each attempt using the eTICI scale; successful recanalisation was defined as eTICI ≥2b and full or near-full recanalisation as eTICI 2c–3. Logistic regression analyses were conducted in the refractory cohort with unadjusted and adjusted models. Results Refractory occlusions occurred in 32.4% (155/479) of patients and were associated with lower admission ASPECTS, reduced intravenous thrombolysis use, and greater comorbidity burden versus non-refractory cases (all p<0.05). Among refractory cases with documented rescue strategies, technique changes occurred after the third attempt in 69.8% (Nimbus 28.6%) and after the fourth in 49.6% (Nimbus 19.3%). Switching to a non-Nimbus device after the third attempt was associated with lower odds of full final recanalisation versus no change (adjusted OR 0.65, 95% CI 0.03–1.4), whereas any Nimbus use during rescue thrombectomy independently increased odds of full final recanalisation (adjusted OR 2.2, 95% CI 1.04–4.66). Conclusions In this observational cohort, rescue use of the Nimbus stent retriever was associated with higher rates of full recanalisation. These findings support further prospective evaluation of Nimbus as a rescue strategy in resistant occlusios. Conflict of interest Matthew Zidan, nothing to disclose