Introduction Large Vessel Occlusion LVO in the setting of underlying intracranial atherosclerosis disease ICAD is challenging with limited data to suggest best therapy

Aim of Study To report a case of using Onyx Resolute stent in setting of LVO with underlying ICAD with very complex anatomy

Methods We present a case of a 79-year-old female who was found acute onset loss of consciousness and weakness in both arms. Her work up showed acute occlusion of mid basilar artery

Results Thrombectomy was successfully performed through radial artery using Infinity catheter and Zoom 71 aspiration catheter with no success. Solitaire stent was then used and showed recanalization with underlying severe stenosis that re-occluded minutes after. We tried introducing Onyx resolute through the Infinity guide catheter and a Sophia catheter with no success due to the tortuosity of the anatomy. This resulted in severe damage to both the infinity and the Sophia catheters. A 6F shuttle was then used to access the right vertebral artery and Navien 5F was then used to gain access over phenom 21 catheter. The phenom 21 catheter was then used to access left PCA. This catheter was then exchanged out over a stiff run-through wire and the Onyx Resolute stent was then introduced successfully and inflated in place. Patient recovered from her stroke with minor deficit

Conclusion Onyx Resolute might be indicated for ICAD in LVO settings. Its stiff system needs better tools to be able to navigate tortuous anatomy

Disclosure of Interest The authors have nothing to disclose.