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Introduction Acutely symptomatic ICAD lesions are usually treated by intracranial balloon angioplasty and/or stenting. Catheter mediated ‘Dotter’ angioplasty is commonly used for extracranial carotid artery steno-occlusive lesions but hasn’t been well described for intracranial circulation. The carrier is a novel ledge-reducing catheter that helps deliver aspiration catheters intracranially. It has a tapered distal segment measuring 15-20 mm that enlarges to 0.059’(1.48mm)-0.069’(1.73mm) outer diameter depending on selected size and can be utilized for Dotter angioplasty intracranially. We report our initial center experience (Carrierplasty) of treated patients.Materials and Methods Retrospective analysis of all patients who underwent off-label carrierplasty as part of endovascular treatment for LVO between 2024-2025.Results We identified 6 patient who underwent carrierplasty as part of mechanical thrombectomy for ELVO. Median age was 74 years and 5 (83%) males. 16% were Hispanics and rest were Caucasians. Baseline MRS 0 and median baseline NIHSS score was 6. Only 1/6 patient was on aspirin and 1/6 was on apixaban pre-op and rest were anti-thrombotic naive. 50% of patients received IV tenecteplase. ICAD locations were ICA (1), M2 (3), A2 (1), Basilar (1). Baseline eTICI scores were 0 and 1 in 16% patients respectively, 2a and 2b in 33% patients respectively. Primary aspiration thrombectomy before angioplasty was done in 5/6 patients with median pass(es) of 1. Median number of carrierplasty attempts was 2. Subsequent balloon angioplasty was done in 1/6 (16%), and same patient also underwent subsequent intracranial stenting with Onyx Frontier 3x12mm stent. After carrierplasty, 100% patients had improvement in degree of stenosis to mild residual stenosis. Final eTICI scores were 2b in 33.3% and 2c in 66.7% patients respectively. There were no procedural related complications including dissections or perforations. 1/6 patient had asymptomatic SAH and 1/6 patient had asymptomatic PH1 hemorrhagic conversion. All but one patients were discharged on DAPT and 1/6 patient was discharged on DOAC due to concurrent Afib. Median discharge MRS was 3 and 90 day MRS was 1.Conclusions Intracranial dotter angioplasty using Carrier delivery catheter as first line approach for endovascular treatment of symptomatic ICAD lesions may be a safe, feasible, and effective option to improve luminal caliber and restore flow. This needs to be validated in larger studies.Disclosures M. Ismail: None. R. Goldstein: None. I. Quraishi: None. E. Biag: None.Abstract E-354 Figure 1