ABSTRACT NUMBER: ESOC2026A2215 ACUTE ISCHEMIC STROKE AND NEUROLOGICAL DEFICITS AFTER CORONARY ANGIOGRAPHY: A TEN-YEAR MULTICENTRE RETROSPECTIVE STUDY

Abstract Background and aims Acute neurological deficits may occur following coronary angiography (CAG). However, data regarding the proportions of true acute ischaemic strokes (AIS) and the safety of reperfusion therapies are limited. This study aims to describe the incidence and nature of neurological deficits following CAG, and to assess the safety of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT). Methods We conducted a retrospective multicentre study using standardised data collected from three high-volume centres in Wallonia, Belgium, which had dedicated stroke units and coronary catheterisation laboratories between 2016 and 2025. All patients with acute neurological symptoms following CAG were included. Results A total of 96 patients were included (median age: 71.5 years; 35 females; median NIHSS: 3; 52 therapeutic CAG). 48 patients (50%) had confirmed AIS and 8 (8%) had a transient ischaemic attack, whereas 23 (24%) were diagnosed with stroke mimics, and 17 (18%) had an undetermined diagnosis. AIS occurred more frequently in men and in patients with atrial fibrillation. Stroke mimics were more frequently associated with aphasia. 14 patients underwent acute reperfusion therapy (IVT and/or MT). IVT was often withheld due to prior heparin administration. No major complication related to reperfusion therapy was observed, except one haemorrhagic transformation in a patient who underwent MT after high-dose heparin. Conclusions Among patients presenting with neurological deficits after CAG, only half had confirmed AIS. MT appeared safe even in the context of prior heparin administration, while IVT was rarely used. These findings suggest that acute stroke management is feasible and appears safe in this specific clinical setting. Conflict of interest Name of author: nothing to disclose