Introduction The treatment of intracranial stenosis due to ICAD is controversial. This could be explained by a lack both of standardization of the patient and of materials dedicated for ICAD. We report our experience with the Pegasus stent in the treatment of intracranial stenosis, with underlying ICAD, as rescue therapy in LVO.

Aim of Study Evaluate the technical feasibility, efficacy and security profile of the Pegasus stent (Phenox), for the treatment of intracranial stenosis with underlying ICAD, in acute settings.

Methods We conducted retrospective analysis of rescue stenting cases, treated with Pegasus stent at our Department from June 2022 to November 2023. All patients had LVO at CT scan with ASPECT > 6. At least 1-2 mechanical thrombectomy passes were done. The periprocedural therapy was administration of bolus + manteinance of Tirofiban and DAPT for 3 months. Primary end-point was mRS 0-2 at 3 months. Secondary end-point was re-stenosis due sub-intimal hyperplasia at DSA at 6 months.

Results Pegasus stent was correctly deployed in 11 patients. LVO occlusion site was in the anterior circulation in 9/11 cases. In 4/11 cases was necessary angioplasty pre-stenting and in 2/11 post-stenting. No periprocedural complications were recorded. 2/11 developed asymptomatic intracranial hemorrhage, with complete resolution before the discharge.

mRs at 3 months were < 2 in all cases. Only 1/11 patient developed low subintimal hyperplasia (M1 segment), at DSA at 6 months.

Conclusion This small single-center retrospective study demonstrates a good feasibility of using Pegasus stent as a rescue therapy of LVO with underlying ICAD.