ABSTRACT NUMBER: ESOC2026A578 CHARACTERISTICS AND PREDICTORS OF UNSUCCESSFUL RECANALIZATION FOLLOWING ENDOVASCULAR THROMBECTOMY: A MULTICENTER COHORT STUDY FROM THE EVATRISP COLLABORATION

Abstract Background and aims Successful target vessel recanalization in patients with LVO is associated with favorable clinical outcomes. Conversely, unsuccessful recanalization (UR) is associated with poor outcomes. UR occurs in up to 30% of EVT procedures and there are significant knowledge gaps in identifying factors associated with UR. Methods Prospectively enrolled EVT-treated patients from the EVATRISP registry were included. Included patients had to have data on pre-stroke and 3-month functional status and recanalization status at the end of EVT. UR was defined as mTICI score<2b and compared with successful recanalization (mTICI≥2b). Regression analyses were performed to identify predictors of UR, and a predictive tool was subsequently constructed. Results Of the 15,549 patients enrolled in EVATRIPS, 10,942 fulfilled entry criteria. 8000 (73%) achieved successful recanalization, while 2942 (27%) had UR. In multivariate analysis, factors independently associated with UR included older age, higher pre-stroke mRS, wake-up stroke, inter-hospital transfer for EVT, higher NIHSS score at presentation, tPA administration and occlusion of M2 segment of the MCA or anterior or posterior cerebral arteries. Dyslipidemia and occlusion of M1 MCA or basilar artery were associated with successful recanalization. UR was associated with poor clinical outcome, and higher mortality rates. A predictive tool derived from these variables demonstrated limited discriminatory ability (AUC 0.579;95% CI 0.567-0.591, p<0.001). Conclusions UR is frequent among patients undergoing EVT and is associated with poor clinical outcomes. Although several pre-EVT factors were independently associated with UR, accurately predicting which patients will experience UR remains highly challenging. Therefore, our findings suggest that all eligible patients should undergo EVT. Conflict of interest Yoel Schwartzmann-nothing to disclose Ronen Leker – received a research grant from HORIZON EUROPE and received speaker honoraria from IscemaView, Boehringer Ingelheim, Pfizer, Jansen, Biogen, Medtronic and Abbott and advisory board honoraria from Jansen all outside the submitted work.