Tushar Trivedi1,2, Ravish Kothari proc mi; class ndependents; var x1 x2; monotone logistic(ndependents= x1 x2 x1*x2); run; Emergent intracranial stenting following mechanical thrombectomy: A case report Tushar Trivedi1,2, Ravish Kothari 1. University of South Carolina; 2. Palmetto Health Hospital, Department of Neurology Introduction Results (continued) Results (continued) Wingspan Stent has been approved by FDA for patients with severe intracranial stenosis to whom medical management is no longer an effective option. However, its use in an acute setting remains debatable. We present a case with fluctuating stroke symptoms who underwent two mechanical thrombectomies and subsequent intracranial thrombectomies and subsequent intracranial stenting during same hospitalization. Final angiogram demonstrated excellent filling of the right MCA vasculature. The patient recovered well from both procedures (NIH 3 at discharge).  Patient was discharged on dual antiplatelet, with a plan to change to a single antiplatelet and an oral anticoagulation medication after 3 months. The patient was admitted for stroke workup. Overnight patient had worsening of symptoms, manifesting as RMCA syndrome (NIH 6). Stat CTA showed a right M1 occlusion. CTP revealed a large penumbra (135 ml) but no core infarct. Patient underwent successful thrombectomy with TICI3 reperfusion, notably angiogram demonstrated high-grade stenosis of the distal M1 segment. MRI showed a small right parietal stroke. Clinical symptoms improved after the procedure (NIH 2).  Patient was continued on anticoagulation and additionally placed on an antiplatelet agent. On the third day of admission, patient’s symptoms worsened acutely (NIH 7). Stat MRI showed new small embolic pattern strokes in the RMCA territory. Repeat CTA showed right M1 occlusion. Considering a large RMCA territory was at risk, an emergent right M1 thrombectomy was performed with subsequent angioplasty and Wingspan stent placement in the same setting.  Conclusions Methods Case report and review of the literature. For patients who underwent mechanical thrombectomy, and remain at high risk for recurrent stroke from severe intracranial stenosis, stenting in acute setting remains a viable option. Results An 85-year-old male with the medical history of hypertension and atrial fibrillation (on anticoagulation), presented with transient dysarthria, left facial droop and left upper extremity paresthesia.