Abstract TP149: Balloon Mounted Drug Eluting Stents for Treatment of Intracranial Atherosclerosis in Emergent Large Vessel Ichemic Stroke

Introduction: Intracranial atherosclerotic disease (ICAD) is an important etiology of ischemic stroke, and often poses a challenge to successful endovascular reperfusion in the setting of emergent large vessel stroke (ELVS). We aimed to evaluate the safety and efficacy of balloon-mounted drug eluting stents (DES) in the treatment of ELVS. Methods: Retrospective review of endovascular database from our comprehensive stroke center from Jan 2021 - Aug 2022. Patients undergoing endovascular therapy for anterior circulation ELVS with ≥70% stenosis in the target vessel treated with DES were included. Patients with tandem cervical carotid lesions requiring stenting were excluded. Primary outcomes were symptomatic intracranial hemorrhage (sICH) within 72 hrs and mortality at 30 days. Secondary outcomes were feasibility of treatment with DES and recurrent stroke within 30 days. Results: Of 359 endovascular stroke interventions performed, 11 patients met the inclusion criteria. Mean age was 60 [51-78], and 7 (64%) were female. Target lesions included 8 M1 (73%), 1 M2 (9%), 1 cavernous ICA (9%), and 1 ICA/M1 junction (9%). Average time from last known well to arterial puncture was 14 hrs, 15 mins [1 hr, 9 mins to 25 hrs, 23 mins]. 2 patients (18%) received IV alteplase. Average ASPECT score 8.3 [5-10], average core infarct 10 mL [0-48] and average mismatch 68 mL [12-179]. 5 procedures (45%) performed via radial access and 6 via femoral (55%), all under general anesthesia. 5 patients (45%) underwent mechanical thrombectomy and 6 (55%) underwent angioplasty prior to DES. 3 (27%) underwent primary DES treatment. Average pre-treatment stenosis was 83% [70-95%], average post-treatment stenosis was 14% [0-45%]. All DES were delivered successfully with no procedural complications. All patients achieved successful reperfusion (8 TICI 3 [73%], 2 TICI 2C [18%], and 1 TICI 2B [9%]). Average NIHSS score was 12.4 [5-28] at presentation and 7.5 [0-20] at 7-10 days. There were no sICH at 72 hrs, and no deaths at 30 days. 1 patient returned with stroke secondary to stent occlusion at 29 days, with successful TICI 3 recanalization following angioplasty. Conclusions: Endovascular treatment of ICAD-related ELVS with DES is safe and effective, and warrants further investigation.