ABSTRACT NUMBER: ESOC2026A1321 EARLY ASSESSMENT OF MIDLINE SHIFT BY TRANSCRANIAL SONOGRAPHY AFTER ENDOVASCULAR THROMBECTOMY

Abstract Background and aims Early prognostication after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) is crucial for guiding clinical management. Transcranial sonography–derived midline shift (MLS) may serve as a noninvasive biomarker for outcome prediction. We aimed to assess whether early dynamics in sonography–derived MLS were associated with clinical and radiologic signs of cerebral injury following EVT. Methods In this prospective single-center study of patients with anterior-circulation AIS treated with EVT, sonography-derived MLS was assessed at <3, 6-24, and 24-48h after recanalization. Outcomes included MRI-based infarct volume, Heidelberg Bleeding Classification (HBC), and 24-hour National Institutes of Health Stroke Scale (NIHSS). MLS at serial time points and MLS progression (increase from first to last exam) were correlated with infarct volume (square-root–transformed) using Pearson’s correlation. MLS was compared between patients stratified by presence of intracranial hemorrhage and early neurological recovery (NIHSS ≤8) using Student’s t-tests. Results Fifty-five patients were included (median age 69 years; 31% female). MLS at 6-24h (r=0.39, p=0.020), 24-48h (r=0.68, p=0.002) and MLS progression (r=0.49, p=0.034) correlated with infarct volume. Patients with early neurological recovery had smaller MLS at 6-24h (0.1 vs 1.3mm, p=0.003) and 24-48h (0.1 vs 2.1mm, p=0.008) and lower MLS progression (0.1 vs 1.1mm, p=0.020) than others. Patients with parenchymal hematomas (HBC ≥PH1) had greater MLS at <3h (0.7 vs -0.1mm p= 0.045) than those without. Conclusions Transcranial sonographic monitoring after EVT provides noninvasive estimates of MLS that may represent early markers of cerebral injury. Larger studies are needed to validate its clinical utility. Conflict of interest Lars Tveit: nothing to disclose