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Introduction Previous RCTs and meta-analyses support the use of mechanical thrombectomy (MT) in low-ASPECTS patients. However, questions remain about edema prevention, patient management, and criteria for decompressive craniectomy (DC), especially since studies on DC predate low-ASPECTS trials.Abstract C90 Figure 1No mismatch between the ischemic core and penumbraCase Description We present the case of a 49-year old man with left hemiparesis, hemianopia, and dysarthria. The symptoms began on December 29 at 9:00 PM. He was transported by ambulance to the nearest hospital at 10:00 PM, NIHSS-14.Initial NCCT and CTA revealed M1 occlusion of the right MCA. IV tPA was initiated, and he was transferred to the nearest stroke center.The patient arrived at the stroke center on December 30 at 1:00 AM with an NIHSS- 15. Neuroimagine on figure 1Based on National Standard and evidence from low-ASPECTS trials, MT was performed. Result-eTICI 2b67%.After MT patient was received hypertonic saline, paracetamol, and followed the FESS protocol. sBP was maintained <140 mmHg. Mobilization was delayed until 72 hours. All measures were used for the potential reduction of the edema.Clinical progress and neuroimagine are presented on figure 2 Discharge - NIHSS-7; mRS-3.Abstract C90 Figure 2Conclusions This case illustrates the challenges and benefits of MT in these patients. We need further international collaboration and trials. Future research should focus on improving the management of these patients after MT, creating new criteria for DC, identifying pharmacological agents to reduce the risk of malignant edema and prevent rapid neurological deterioration in this patient group.Conflict of Interest No