Abstract DP342: Rescue versus First-Line Intracranial Stenting during Thrombectomy for Acute Ischemic Stroke: A Propensity-Weighted Analysis of the RESISTANT Registry

Introduction: Rescue stenting (RS) is a recognized bailout strategy following failed endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). First-line stenting (FLS) has emerged as a potential alternative to avoid vascular injury and improve outcomes. However, direct comparisons between these strategies remain limited. Methods: We conducted a comparative analysis of FLS and RS using data from the RESISTANT registry, an international, multicenter, retrospective cohort of AIS patients who received intracranial stenting during EVT from 2016 to 2023. Patients were categorized by stenting strategy: FLS (stent placed without prior thrombectomy) or RS (stent placed after failed thrombectomy). The primary effectiveness outcome was functional independence (modified Rankin Scale [mRS] 0–2) at 90 days. The primary safety outcome was symptomatic intracranial hemorrhage (sICH). Propensity score inverse probability of treatment weighting (IPTW) was used to adjust for baseline differences. Results: Among 827 patients, 723 were in the RS cohort and 104 in the FLS cohort. Compared to RS, FLS patients more often had diabetes (46.2% vs. 35.2%, p =0.03), prior stroke (46.2% vs. 25.3%, p