<h3>ABSTRACT</h3> <h3>BACKGROUND AND PURPOSE:</h3> Angioplasty and stenting (A&amp;S) have been described as bailout technique in individuals with failed thrombectomy. We aim to investigate Stent retriever AssIsted Lysis (SAIL) with tirofiban prior to A&amp;S. <h3>MATERIALS AND METHODS:</h3> Patients from 2 comprehensive stroke centers were reviewed (2020-2023). We included patients with failed thrombectomy and/or underlying intracranial stenosis who received SAIL with tirofiban prior to intended A&amp;S. SAIL consisted in deploying a SR through the occluding lesion to create a by-pass channel and infuse 10ml of tirofiban over 10 minutes either intraarterially (IA) or intravenously (IV). The SR was re-sheathed before retrieval. Primary endpoints were successful reperfusion (eTICI 2b-3) and sICH. Additional endpoints included 90-day mRS 0-2 and mortality. <h3>RESULTS:</h3> After a median of 3 (IQR 2-4) passes, 44 patients received the SAIL bridging protocol with tirofiban and later they were considered potential candidates for A&amp;S bailout (43.2% IA-SAIL). Post-SAIL successful reperfusion was obtained in 79.5%. A significant residual stenosis (&gt;50%) after successful SAIL was observed in 45.7%. No significant differences were detected according to post-SAIL successful reperfusion (IA-SAIL 80.0% vs IV-SAIL 78.9%; p=0.932), post-SAIL significant stenosis (33.3% vs 55.0%; p=0.203), early symptomatic reocclusion (0% vs 8.0%; p=0.207), or sICH (5.3% vs 8.0%; p=0.721). Rescue A&amp;S was finally performed in 15 (34.1%) patients (IA-SAIL 21.0% vs IV-SAIL 44%; p=0.112). At 90 days, mRS 0-2 (IA-SAIL 50.0% vs IV-SAIL 43.5%; p=0.086) and mortality (26.3% vs 12.0%; p=0.223) were also similar. <h3>CONCLUSIONS:</h3> In stroke patients in which A&amp;S bailout is considered, SAIL with tirofiban, either intraarterial or intravenous, seems to safely induce sustained recanalization, offering a potential alternative to definitive A&amp;S. ABBREVIATIONS: A&amp;S = Angioplasty and stenting, ICAD = Intracranial Atherosclerotic Disease, ICAS-LVO = Intracranial atherosclerosis related large vessel occlusion, EVT = Endovascular Treatment, LVO = Large Vessel Occlusion; MT = Mechanical Thrombectomy; SR = SR Stent Retriever; SAIL = Stent retriever AssIsted Lysis, sICH = Symptomatic Intracranial Hemorrhage.

Stent retriever AssIsted Lysis (SAIL) Technique with Tirofiban: A Potential Bailout Alternative to Angioplasty and Stenting