Abstract Number: Esoc2026a1645 Rescue Stenting in Acute Basilar Artery Occlusion After Failed Mechanical Thrombectomy: A Systematic Review and Meta-Analysis

Abstract Background and aims Rescue stenting (RS) has emerged as a feasible rescue therapy in patients with failed mechanical thrombectomy (MT). However, the evidence in cases of basilar artery occlusion (BAO) is limited. This meta-analysis aimed to evaluate the safety and efficacy of RS in acute BAO patients who failed MT. Methods We conducted a comprehensive search up to December 2025 to include interventional/observational studies. Primary outcomes included successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b–3), re-occlusion, symptomatic intracranial hemorrhage (sICH), 90-day modified Rankin scale (mRS) score 0–2, and mortality. A random-effects model was used and statistical heterogeneity was assessed with I2. We conducted subgroup analyses based on baseline NIHSS. Results Seven studies (871 patients) were included. Three studies compared RS versus no RS, with no significant differences in terms of 90-day mortality (RR = 0.62; 95% CI: 0.35–1.12), sICH (OR = 0.59; 95% CI: 0.06–5.51), or 90-day mRS score 0–1 (RR = 1.96; 95% CI: 0.55–6.97). The pooled rates after RS showed 85% successful reperfusion (95% CI: 74%–97%), 43% complete reperfusion (95% CI: 33%–54%), 13% re-occlusion (95% CI: 1%–26%), 26% 90-day mRS score 0–1 (95% CI: 11%–41%), and 41% 90-day mRS score 0–3 (95% CI: 33%–49%). The 90-day mortality and sICH rates were 4% each. Conclusions RS appears to be a feasible option in acute BAO after MT fails to achieve successful reperfusion. However, randomized trials using a standardized approach and long-term follow-up are warranted. Conflict of interest Dina Essam Abo-elnour: nothing to disclose, Elsayed S. Moubarak: nothing to disclose, Ahmed Amir Samir: nothing to disclose, Omar ElSayed Mohamed Rageh: nothing to disclose, Mohamed S. Elgendy: nothing to disclose, Abdelrahman I. Abdellatif: nothing to disclose, Ahmed L. Youseif: nothing to disclose, Hamza A. Abdul-Hafez: nothing to disclose.