ABSTRACT NUMBER: ESOC2026A1137 SAFETY AND EFFICACY OF RESCUE STENTING FOR ACUTE INTRACRANIAL ATHEROSCLEROTIC LARGE-VESSEL OCCLUSION: BEYOND THE 24-H WINDOW

Abstract Background and aims This study aimed to evaluate the safety and clinical outcomes of rescue stenting in patients with acute ischemic stroke (AIS) due to intracranial atherosclerotic large-vessel occlusion (ICAS-LVO) treated beyond 24 h from symptom onset. Methods We stratified consecutive patients with AIS caused by ICAS-LVO, who underwent rescue stenting between January 2018 and December 2024, by time from symptom onset to endovascular treatment (>24 h vs ≤24 h). Propensity score matching (ratio 1:2) was used to balance baseline characteristics. The primary outcome was 90-day functional independence. Safety outcomes included symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage, and 90-day all-cause mortality. Multivariate logistic regression was performed within the >24-h cohort to identify factors associated with unfavorable outcomes. Results Among 289 patients, 96 were treated beyond 24 h and 193 within 24 h. The 90-day functional independence rates were comparable between groups. No significant differences were observed in all-cause mortality or sICH. The incidence of intracranial hemorrhage was significantly lower in the >24-h group. Within the >24-h cohort, older age (≥60 years) and higher baseline National Institutes of Health Stroke Scale score (≥10) were associated with unfavorable functional outcomes. Conclusions Rescue stenting beyond 24 h from symptom onset was not associated with worse clinical or safety outcomes compared with treatment within 24 h in carefully selected patients with AIS due to ICAS-LVO. These findings suggest the feasibility of rescue stenting in selected cases and that age and baseline stroke severity influence outcomes among patients treated beyond conventional time windows. Conflict of interest Name of author: nothing to disclose