Abstract Number ‐ 36: Acute Angioplasty And/or Stenting Posterior Circulation Intracranial Atherosclerotic Disease Related Large Vessel Occlusion

Introduction With prior studies showing the value of percutaneous transluminal angioplasty and stenting (PTAS) for rescue of acute large vessel occlusions (LVO) of anterior circulation in patients with underlying intracranial atherosclerotic disease (ICAD), we investigated the safety and efficacy of PTAS in posterior circulation intracranial atherosclerosis‐related occlusions (ICAS‐O). Methods By utilizing a prospectively collected endovascular database at a comprehensive stroke center from January 2016‐May 2022, variables such as demographics, co‐morbid conditions, symptomatic intracerebral hemorrhage (ICH), mortality rate at discharge, recanalization rate, modified thrombolysis in cerebral infarction score (mTICI) and favorable clinical outcome via modified Rankin Scale (mRS) were examined. The outcomes between acute PTAS + MT in the anterior and posterior circulation groups were then compared and analyzed. Results Within a group of 75 acute ischemic stroke (AIS) patients who underwent rescue PTAS, 15 (20.0 %) belonged to the posterior circulation ICAS‐O group. Baseline characteristics between the posterior and anterior groups were similar, except for gender (6.7% vs 45.0%) and atrial fibrillation (21.7% vs 0.0%). While there was no statistical difference in discharge NIH Stroke Scale(18% vs 23%, P = 0.860) or favorable outcome (modified Rankin Scale ≤ 2) at 90 days (46.7% vs 38.7 %, P = 0.477) between the posterior and anterior ICAS‐O groups respectively, symptomatic ICH rate was higher in the anterior group (11.7 vs 6.7%, P = 0.495). Conclusions Rescue angioplasty and stenting seems to be a safe and efficacious treatment option for ICAS‐related LVO of posterior circulation. Future larger, multicenter prospective studies would provide further analysis and allow for corroboration of the results of our study.