Abstract TP043: "Submaximal Stenting" for Rescue Therapy in Large Vessel Occlusion (LVO) Acute Ischemic Stroke Secondary to Intracranial Atherosclerotic Disease (ICAD): A Single-Center Case Series

Background: Intracranial atherosclerotic disease (ICAD) is a leading cause of ischemic stroke (IS) globally. We introduce “submaximal stenting”—deliberate stent deployment at less-than-nominal balloon pressures tominimize vessel injury and improve safety. This technique, performedwith Resolute Onyx TM and Onyx Frontier TM zotarolimus-eluting stents, may offer advantages over traditional stenting. Methods: We conducted a retrospective cohort study at a single comprehensivestroke center, including patients who underwent submaximal stenting with Resolute Onyx TM or Onyx Frontier TM drug-eluting stents (DES) foracute ischemic stroke due to ICAD-related large vessel occlusion (LVO) between January 2020 and July 2025. Primary outcomes were technical success—defined as maintained patency of the treated artery without adjacent vessel occlusion and normal arterial/venous phaseopacification on DSA—and procedural safety, defined as absence ofvessel rupture. Secondary outcomes included in-stent thrombosis, symptomatic intracranial hemorrhage (sICH), and outcomes assessedby modified Rankin Scale (mRS) and NIHSS at discharge and follow-up. This technique is illustrated in Figure 1 . Results: We included 42 patients (median age 59.0 years IQR 53.5-72.5; 66.7% male; 66.7% African American/Black) with ICAD-related LVO who underwent submaximal rescue stenting. All had severe (70-99%) residual stenosis, most due to atherosclerosis (97.6%). The most common vessels treated were M1 MCA (52.3%), basilar artery (19.0%), and ICA (14.3%). Technical success and vessel patency were achieved in all cases. Symptomatic intracranial hemorrhage occurred in 14.3%, in-stent thrombosis in 16.7%, and vessel restenosis in 4.8%. Median hospital stay was 9.5 days (IQR 6.0–17.0), and follow-up was 5.0 months. Median discharge NIHSS was 13 (IQR 4.0–17.0), and mRS was 4.0 (IQR 2.0–5.0). All patients underwent follow-up vascular imaging. Complications are illustrated based on duration since admission in Figure 2 . Conclusions: Submaximal stenting with Resolute Onyx™ and Onyx Frontier™ DES is technically feasible and appears safe as rescue therapy for acute IS related to ICAD-LVO.