ABSTRACT NUMBER: ESOC2026A2235 ENDOVASCULAR TREATMENT OF YOUNG ADULTS WITH ISCHEMIC STROKE, A COHORT STUDY FROM THE INTERNATIONAL EVA-TRISP COLLABORATION

Abstract Background and aims The incidence of acute ischemic stroke (AIS) is increasing among young adults, yet data on outcomes in this group remain limited due to small sample sizes. This study aimed to compare functional and safety outcomes after EVT between young adults and older adults in a large international cohort. Methods In this prospective multicenter cohort study, data from the EVA-TRISP registry (17 centers across 9 countries, 2015-2025) were analyzed. Young patients (aged 18–49 years) treated with EVT were compared to those aged ≥50 years using multivariable regression models. Outcomes included favorable functional status (modified Rankin Scale [mRS] 0–2), successful recanalization, symptomatic intracranial hemorrhage (sICH; defined by ECASS II criteria), and all-cause mortality at 3 months. Results Of 12,933 patients treated with EVT, 823 (6.4%) were young adults. Compared to older patients, young adults were more frequently male, had lower admission NIHSS scores, received intravenous thrombolysis more often, and had fewer vascular risk factors except for smoking. Young adults achieved higher rates of favorable functional outcome (67.3% vs 42.4%; adjusted odds ratio aOR 1.84, 95% CI 1.48–2.30) and successful recanalization (77.1% vs 73.4%; aOR 1.39, 95% CI 1.12–1.73), with lower mortality (7.5% vs 24.2%; aOR 0.32, 95% CI 0.22–0.47). Rates of sICH were similar between groups (3.6% vs 4.6%; aOR 0.72, 95% CI 0.47–1.10). Conclusions In this large, international real-world cohort, young adults with AIS treated with EVT more frequently achieved favorable functional outcomes, higher recanalization rates, and lower mortality compared to older adults, with comparable rates of sICH. Conflict of interest Miranda Nybondas: nothing to disclose, Nicolas Martinez-Majander reports funding from the Finnish Medical Foundation, Sami Curtze: nothing to disclose, Annika Nordanstig: nothing to disclose, Susanne Wegener reports speaker honoraria from Amgen, Springer, Teva Pharma, ADVISIS-AG, FOMF, Astra Zeneca, and a consultancy fee from Bayer and Novartis; all outside this work., Patrik Michel: nothing to disclose, Mirjam Heldner reports grants from SITEM Research Support Funds and Swiss National Science Foundation, Swiss Heart Foundation, not directly related to this manuscript., Christian Nolte: reports personal fees from AstraZeneca/Abbot, Alexion,/ (paid to the institution);, Astra-Zeneca, Bristol-Myers Squibb, Daiichi Sankyo, Novartis, Pfizer, Portola and Takeda, all outside the submitted work. Tolga Dittrich: nothing to disclose, Henrik Gensicke: nothing to disclose.