E-029 Rescue intracranial angioplasty with or without stenting in acute ischemic stroke

Introduction The appropriate management of acute ischemic strokes secondary to hemodynamic intracranial atherosclerotic disease refractory to the conventional mechanical thrombectomy remains unclear. We aimed to investigate the clinical outcome of the patients who underwent rescue intracranial angioplasty with or without stenting in the setting of acute ischemic stroke at our institution. Method This is a retrospective single-arm observational study to evaluate the effect of acute rescue angioplasty with or without stenting on clinical symptom burden and functional outcome. We included all patients that underwent such rescue intervention within 7 days of presenting with acute ischemic stroke with large vessel occlusion between the years of 2017 to 2020. We evaluated the change in NIHSS from presentation to hospital discharge as well as mRS at discharge and 3 months. We further evaluated for stent or vessel reocclusion as well as symptomatic hemorrhagic conversion as the cause of clinical decline. Results There were twenty procedures in nineteen patients during this time period. In three procedures acceptable caliber improvement was achieved using angioplasty alone (15%), with the other 17 procedures requiring a stent. Fourteen procedures (70%) resulted in improvement in NIHSS following the procedure and upon discharge. Out of the 6 procedures with worsening clinical outcome, 1 had reocclusion of the lesion, 2 with symptomatic hemorrhagic conversion, and 1 with perforator occlusion. Eleven cases resulted in mRS less than or equal 2 at 3 months and 3 patients had passed away by 3 months. Conclusion Even though rescue angioplasty with or without stenting can have a high rate of periprocedural morbidity, it leads to marked clinical improvement in the majority of the patients in this selected cohort. Disclosures K. Khatibi: None. A. Mowla: None. H. Saber: None. L. Ponce Mejia: None. N. Kaneko: None. G. Duckwiler: None. S. Tateshima: None.