ABSTRACT NUMBER: ESOC2026A2484 TO STENT OR NOT TO STENT - THAT IS THE QUESTION

Abstract Background and aims Rescue stenting (RS) as a salvage method for reperfusion in mechanical thrombectomy (MT) for acute ischemic stroke (AIS) has improved clinical outcomes with comparable periprocedural complications despite concurrent IV thrombolysis and aggressive antiplatelet therapy during and after stenting. This retrospective review compared periprocedural complications and clinical outcomes in AIS patients who underwent MT with and without rescue stenting. Methods Using logistic regression, we retrospectively analyzed data for 325 patients with AIS who underwent MT between January 2022-October 2024. Degree of recanalization was evaluated using the Modified Thrombolysis in Cerebral Infarction (mTICI) score; clinical outcomes at 90 days were assessed using modified Rankin score (mRS) at discharge or 90 days dichotomized for desirable (mRS 0-2) and undesirable (mRS 3-6) functional outcomes. Bleeding events included intracranial hemorrhage (ICH) at 48 hours and systemic bleeding requiring transfusion. Results 80 of 325 patients (19-99 years old, 54% female with NIHSS 1-34) underwent rescue stenting; these patients did not have more bleeding complications or worse functional outcomes than those without rescue stents (p=0.747 and p=0.882, respectively). Bleeding complications were not affected by IV thrombolysis (p=0.675) and functional status was not modified by stent location (intracranial vs. Carotid) (p=0.242). Conclusions In this sample, rescue stenting did not significantly affect clinical outcomes, likelihood of ICH or severe systemic bleeding in patients undergoing MT for AIS, nor did stent location or IV thrombolytics increase complication risk. In contrast to prior studies, despite no increase in complication risk, rescue stenting failed to provide significant long-term clinical benefits in this sample. Conflict of interest Suzan Farris: nothing to disclose. Patrick Reynolds: nothing to disclose. Cheryl Bushnell: nothing to disclose. Mathieu Norcross: nothing to disclose.