Introduction/Purpose Intracranial atherosclerotic disease (ICAD) is a major global cause of ischemic stroke. While traditional stenting may pose risks of vessel injury, this case series introduces “submaximal stenting," in which stents are deployed at less‐than‐nominal balloon pressures to minimize vessel trauma and enhance safety in large vessel occlusion (LVO) rescue therapy. Materials/Methods A retrospective cohort analysis was conducted at a comprehensive stroke center, examining patients treated between January 2020 and July 2025 with submaximal deployment of drug‐eluting stents for ICAD‐related LVO. Technical success was defined by sustained vessel patency and imaging‐confirmed flow. Procedural safety, in‐stent thrombosis, symptomatic intracranial hemorrhage (sICH), and vessel restenosis were recorded. Clinical outcomes were assessed with the modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) at discharge and follow‐up. Results Among 42 identified patients (median age 59 years; 66.7% male), all presented severe residual stenosis (70–99%), predominantly from atherosclerosis. Primary vessels treated included M1 MCA, basilar artery, and ICA. Technical success was achieved in 100% of cases. Complications included sICH (14.3%), in‐stent thrombosis (16.7%), and vessel restenosis (4.8%). Median hospital length of stay was 9.5 days, and median follow‐up 5 months. Discharge NIHSS and mRS were 13 and 4.0, respectively. All received vascular imaging post‐procedure. Complications and outcomes by patient timeline are summarized (Figure 1 and Figure 2). Conclusion Submaximal stenting appears to be a feasible and effective rescue technique in LVO stroke due to ICAD, demonstrating high technical success and acceptable safety parameters. These findings support further investigation and multicenter validation of submaximal stenting as a standardized therapeutic approach in acute ICAD‐related LVO management. Graphics/Tables : Figure 1. Submaximal stenting procedural steps: Panel A depicts lesion access, Panel B shows stent deployment at sub‐nominal pressure, and Panel C illustrates vessel conformation post‐angioplasty. Figure 2. Timeline chart displaying post‐procedural complications by patient. image image
Chigurupati et al. (Sat,) studied this question.
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