Abstract WP252: Impact of intracranial stenosis on mechanical thrombectomy outcome

Introduction: Underlying Intracranial atherosclerotic disease (ICAD) may influence mechanical thrombectomy recanalization, leading to an increased number of passes before rescue techniques are adopted. Initial suspicion of underlying ICAD could help in the early adoption of rescue techniques, reducing the total number of passes and increasing the chances of sustained final recanalization and favorable outcomes. We aimed to evaluate whether the presence of intracranial stenoses other than the target occlusion is related to potential underlying symptomatic ICAD, influencing recanalization success. Methods: We retrospectively analyzed 200 consecutive patients who underwent mechanical thrombectomy for acute ischemic stroke at our center between November 2022 and January 2024. Baseline angiograms were reviewed to assess the presence or absence of intracranial stenosis lesions (IS+ Vs IS-) different than the target occlusion. We evaluated the impact of IS+ on different efficacy outcome variables: final complete recanalization (eTICI2c-3), total number of passes, procedural duration, and use of bailout technique (angioplasty, stenting, GP2b2a infusion) Results: Of the 200 evaluated patients, 52 (26%) IS+ were found. There were no significant differences in baseline characteristics between IS+ and IS- patients. Patients with IS+ achieved less often complete recanalization after the final pass (47.7% Vs. 69.1%;p=0.012) and underwent a higher total number of thrombectomy passes (mean: 2.4 vs. 1.9; p<0.01). Bailout strategies were required more often in the IS+ group (34.6% Vs12.8%; p=0.001), and procedural times were longer (56.6 Vs 69.7 minutes; p=0.018). At discharge, patients in the IS+ group had a higher NIHSS score (7.5 Vs 3; p=0.036). Conclusions: Our findings suggest that the presence of an intracranial stenosis different than the target occlusion on the initial angiogram may not only predict the complexity of the procedure but also suggest its underlying etiology. Active identification of these lesions on baseline angiograms could help anticipate treatment strategies, potentially advancing the adoption of bailout strategies. Further research is warranted to explore the diagnostic value of multiple intracranial stenosis in patients undergoing mechanical thrombectomy.