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Introduction ICAD-LVO accounts for 10–30% of LVO cases, with risk factors including hypertension, diabetes, ethnicity, and age. Standard treatment is IVT and EVT, but ICAD-LVO carries higher morbidity, mortality, and re-occlusion (30–50% vs. 5% in cardioembolic strokes). RT options include intra-arterial antiplatelets, angioplasty, and stenting, but the optimal approach remains unclear. This first Philippine study on RT in ICAD-LVO evaluates its effectiveness and clinical impact.Aim of Study To determine the clinical outcomes of patients undergoing rescue intra-arterial therapy for emergent large vessel occlusion secondary to intracerebral atherosclerotic disease admitted at The Medical City (TMC) from September 2018 to April 2024.Method A retrospective review of emergent LVO cases undergoing cerebral angiography for EVT (Sept 2018–July 2024) included patients who received RT for ICAD-LVO. Collected data included demographics, admission MRS and NIHSS, comorbidities, maintenance antithrombotics/anticoagulants, ASPECTS/MR ASPECTS, IV thrombolysis history, RT type, in-hospital mortality, and discharge MRS.Results Among 101 LVO patients, 10 had ICAD-LVO and received rescue therapy. Mean age was 65, 80% male, all hypertensive, and 50% diabetic and dyslipidemic. Most (80%) received IA tirofiban (960 mcg), one had emergency stenting, and one received IA alteplase. No early neurological improvement was seen. At discharge, 80% had an mRS of 3–5. Hemorrhagic transformation occurred in 20% but was asymptomatic. One (10%) died due to care withdrawal, not RT.Conclusion ICAD-LVO poses challenges in revascularization with poor outcomes. IA tirofiban appears safe but lacks acute clinical benefits. Long-term studies are needed to assess RT’s safety and efficacy.Conflict of Interest No