ABSTRACT NUMBER: ESOC2026A1369 ROTATIONAL THROMBOELASTOMETRY DURING ENDOVASCULAR TREATMENT IN ACUTE ISCHEMIC STROKE. AN EXPLORATORY STUDY

Abstract Background and aims Rotational thromboelastometry (ROTEM) allows real-time assessment of whole-blood coagulation. Data on dynamic coagulation changes during endovascular treatment (EVT) in acute ischemic stroke are scarce. We conducted an exploratory analysis assessing the feasibility of ROTEM as a point-of-care tool to support EVT Methods This prospective, single-center pilot study included consecutive EVT patients between January-2025 and December-2025. ROTEM assessment was performed at four predefined time points before and during EVT (S1-S2-S3-S4; Figure 1). ROTEM parameters analyzed were clotting-time (CT), maximum-clot firmness (MCF), and early-clot amplitude/area (AR5-AR20). EVT-related variables included first-pass effect (FPE), excellent final-recanalization (TICI2C–3), number of attempts, and puncture-to-recanalization time. Exploratory correlation and group-comparison analyses were performed Results Nineteen patients were included (mean age 77.4 SD±10.9years; median baseline NIHSS 18 [IQR9–21]), nine received intravenous-thrombolysis. Excellent-recanalization was achieved in nine cases. Median number of passes was 1 (IQR1–3) and median puncture-to-recanalization time was 58 minutes(IQR:40–70). S2-CT showed a positive correlation with the number of passes (r=0.743, p<0.001), while S2-AR5 correlated with puncture-to-recanalization time (r=0.472, p=0.046). Patients achieving excellent reperfusion had lower S3-MCF (55.6 SD±8.2 vs 63.3 SD±4.8 mm; p=0.040). FPE was associated with lower S2-AR20 (45.6 SD±26.6 vs 58.2 SD±7.1 mm2; p=0.013). Conclusions Serial, real-time ROTEM assessment during EVT is feasible showing exploratory associations with key EVT-procedural-variables. This approach may support intraprocedural decision-making on EVT strategy and warrants further validation in larger studies. Conflict of interest Nothing to disclose Figure 1 - belongs to Methods