381 Predictors of Symptomatic Hemorrhage in DMVOs Treated With MT

INTRODUCTION: Acute ischemic stroke (AIS) caused by distal medium vessel occlusions (DMVO), represents asignificant proportion of overall stroke cases. While intravenous thrombolysis (IVT) has been aprimary treatment, advancements in endovascular procedures have led to increased use ofmechanical thrombectomy (MT) in DMVO stroke patients. However, symptomatic intracerebralhemorrhage (sICH) remains a critical complication of AIS, particularly after undergoingintervention. METHODS: This retrospective analysis utilized data from the Multicenter Analysis of Distal Medium VesselOcclusions: Effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centersacross North America, Asia, and Europe. The primary outcome measured was sICH, as definedper ECASS-II criteria. Univariable and multivariable logistic regression, were employed toidentify predictors of sICH. RESULTS: Among 1,637 DMVO stroke patients, 188 (11.5%) developed sICH. Key predictors of sICH inDMVO patients treated with MT included older age (Adjusted odds Ratio [aOR]: 1.01; 95%Confidence Interval [CI]: 1.00-1.02), distal occlusion site (M3, M4) compared to medium occlusions (M2) (aOR: 1.75; CI: 1.13-2.70), prior use of antiplatelet drugs (aOR: 1.70; CI: 1.21-2.40), lower ASPECTS scores (aOR: 0.74; CI: 0.66-0.83), higher pre-operative blood glucoselevel (aOR: 1.00; CI: 1.00-1.01), and procedural factors such as the number of passes (aOR:1.29; CI: 1.18-1.41) and successful recanalization (TICI 2b-3) (aOR: 0.60; CI: 0.40-0.92). CONCLUSIONS: The study provides critical insights into the predictors of sICH in patients undergoing MT forDMVO, emphasizing the importance of age, distal occlusion site, prior use of antiplatelet drugs,lower ASPECTS scores, higher pre-operative blood glucose level, and procedural factors such asthe number of passes and successful recanalization. These insights highlight the need forpersonalized treatment strategies. The study's findings also highlight the need for further researchevaluating these variables.