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Objective:
The optimal treatment strategy for patients with acute large vessel occlusion (LVO) due to underlying intracranial atherosclerotic stenosis is unclear. The purpose of this study was to investigate the safety and efficacy of angioplasty and angioplasty plus stenting for underlying atherosclerotic stenosis in such patients.

Materials and Methods:
From January to June 2020, total 138 patients underwent angioplasty without and with stenting for the rescue therapy of underlying atherosclerotic stenosis during endovascular treatment for acute LVO in the anterior and posterior circulations. Procedure-related complications and clinical outcomes were compared between 2 groups. A patency of treated artery was assessed with follow up CT angiography during hospitalization for the assessment of recoil of the treated artery, early reocclusion, and positive remodeling.

Results:
A total of 50 patients received angioplasty and 88 patients were treated with angioplasty plus stenting. Instant reocclusion occurred in 16 patients (11.6%) during procedure. Extravasation occurred in 2 patients of stenting group. Subarachnoid hemorrhage was found in 26 patient (18.8%) on immediate follow up CT. The rates of procedure-related complications are not different between 2 groups. Recoil of the treated artery was more frequently observed in the angioplasty group than the angioplasty plus stenting group (28.0% vs 1.1%, p < 0.005), whereas positive remodeling was more common in the angioplasty plus stenting group than the angioplasty group (22.7% vs 4.0 %, p = 0.004). There were no significant differences in the rates of early reocclusion, symptomatic hemorrhage. and favorable outcome.

Conclusion:
Both angioplasty and angioplasty plus stenting are both save and effective in the treatment of underlying atherosclerotic stenosis in acute stroke patients with LVO. Additional stenting might be helpful for preserving arterial patency after angioplasty for the target stenosis in such patients.