Abstract WP255: Vascular calcification burden and outcome of endovascular therapy in acute ischemic stroke

Background: Vascular calcification has been linked to poor outcomes in ischemic stroke, but most prior studies have focused on intracranial arteries alone. The prognostic impact of combined calcification burden across multiple vessel beds in patients undergoing endovascular therapy (EVT) remains unclear. Objective: To determine whether automated, quantitative calcification measurement in the aortic arch, cervical internal carotid artery (ICA), and intracranial ICA predicts EVT outcomes. Methods: We retrospectively analyzed patients with acute ischemic stroke treated with EVT from 2018–2022. CT angiography (CTA) studies underwent automated calcification quantification using a deep learning U-net model. Calcification burden was calculated separately for each vessel bed and combined. High burden was defined as ≥75th percentile of the cohort. Clinical, imaging, and procedural data were collected. Primary outcomes were favorable recanalization (TICI 2b–3) and favorable functional outcome (mRS 0–2) at 90 days. Multivariable logistic regression adjusted for clinical and procedural covariates. Results: A total of 384 patients were included (mean age 64.4 ± 15.9 years, 48.2% female). Median admission National Institute of Health stroke scale (NIHSS) was 14, median baseline modified Rankin Scale (mRS) was 0, 67% had middle cerebral artery occlusion, and 34% received IV thrombolysis. There was no association between calcification burden and favorable recanalization rate (Figure 1). Higher cervical ICA burden was associated with longer time from groin stick to first pass (p=0.014), but no difference observed in number of passes. Greater cervical ICA and aortic arch calcification were associated with lower likelihood of favorable functional outcomes at 90-days (p = 0.007 and p = 0.009, respectively; Figure 2). In multivariable models, baseline NIHSS and pre-stroke mRS but not vascular calcification remained independent predictors of functional outcome. Conclusion: High calcification burden in the cervical ICA and aortic arch is associated with worse unadjusted functional outcomes after EVT, but NIHSS and mRS remain independent factors. Higher cervical ICA calcification is associated with longer procedural time but does not affect the outcome.