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Introduction Failure to achieve durable reperfusion after mechanical thrombectomy (MT) remains a major determinant of poor outcomes in acute ischemic stroke (AIS). Rescue balloon angioplasty and/or stenting (RS) is increasingly used in this setting, particularly in cases of re-occlusion and residual severe stenosis suspected to be from intracranial atherosclerotic disease. However, contemporary evidence—including large multicenter registries—has yielded heterogeneous results. We performed an updated meta-analysis to evaluate the efficacy and safety of RS after failed MT.Methods A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted through February 2026. Comparative studies evaluating RS versus no RS after failed MT were included. The primary outcome was 90-day functional independence (modified Rankin Scale [mRS] 0-2). Secondary outcomes included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Random-effects models with restricted maximum likelihood estimation and Hartung-Knapp adjustment were applied. Prespecified subgroup analyses were performed by circulation territory.Results Nineteen studies including 3,701 patients (1,275 RS; 2,426 no RS) met inclusion criteria. RS was associated with significantly higher odds of functional independence (OR 1.67, 95% CI 1.27-2.19; I 2=52%) and lower mortality (OR 0.60, 95% CI 0.45-0.79; I2=35%). There was no increase in sICH (OR 0.99, 95% CI 0.73-1.34; I2=0%). Subgroup analysis demonstrated a pronounced and consistent benefit in posterior circulation stroke, with improved functional independence (OR 2.44, 95% CI 1.74-3.43) and substantial mortality reduction (OR 0.36, 95% CI 0.23-0.56), whereas anterior circulation outcomes showed more modest effects.Conclusion Rescue balloon angioplasty or stenting following failed thrombectomy is associated with improved functional outcomes and reduced mortality without excess hemorrhagic risk, with particularly strong benefit in posterior circulation stroke. These findings support consideration of RS in carefully selected patients and underscore the need for prospective randomized trials to define optimal indications and procedural strategies.Disclosures W. Lee: None. W. Luo: None. T. Tran: None. R. Correia Maciel: None. A. Dmytriw: None. E. Raz: None. P. Chen: None. S. Sheth: None. M. Nahhas: None. R. Regenhardt: None.Abstract O-017 Table 1Abstract O-017 Table 2