ABSTRACT NUMBER: ESOC2026A1417 MEDIUM-VESSEL OCCLUSION RECANALISATION AFTER MEDICAL MANAGEMENT, AND CLINICAL OUTCOME

Abstract Background and aims In acute ischemic stroke (AIS) with medium-vessel occlusion (MeVO), intravenous thrombolysis (IVT) is the currently recommended acute recanalisation therapy. We aimed to evaluate the association between imaging-proven recanalisation (IPR) and clinical outcome in MeVO-AIS treated with conservative treatment (CTr) or IVT. Methods From our local stroke registry we included all consecutive patients with MeVO-AIS receiving CTr or IVT. IPR was defined as complete recanalisation on 12-24-hour CTA/MRA. Clinical outcomes were 24h-NIHSS and 3-month modified-Rankin-Scale (mRS). The association of treatment (CTr vs. IVT) and recanalisation (IPR vs. no IPR) with clinical outcomes was assessed using propensity-score-weighed regression models. Weighting accounted for pre-stroke mRS, baseline NIHSS, age, sex, onset-to-door time, MeVO localisation, vascular risk factors. Results Among 229 patients with MeVO, 52 received CTr and 177 IVT. Overall, 114 had IPR. Patients with IPR had more M3 occlusions, fewer P1-P3 occlusions, and shorter onset-to-door times. IVT was significantly associated with IPR (aOR=16.8, 95%CI=5.37-48.74) but not with 3-month mRS. In the overall cohort, IPR was associated with greater 24-hour NIHSS improvement (beta-coeff=1.93, 95%CI=0.39-3.47), better 3-month mRS (pswOR=2.50, 95%CI=1.56-4.00), and higher rates of excellent outcome (mRS 0-1, pswOR=3.10, 95%CI=1.72-5.59). The same associations between IPR and clinical outcomes were observed in the cohort of IVT-treated patients. Conclusions In MeVO-AIS treated with medical management, IPR is associated with improved functional outcome. While IVT increased the likelihood of IPR, persistent occlusion remained frequent, suggesting that more effective revascularisation strategies are needed to improve recanalisation rates and thus clinical outcomes. Conflict of interest François Fenter: nothing to disclose. Vincent Dunet: nothing to disclose. Patrik Michel: nothing to disclose. Davide Strambo: advisory board for Boehringer Ingelheim. Figure 1 - belongs to Results