ABSTRACT NUMBER: ESOC2026A1385 CONSERVATIVE VS AGGRESSIVE ANTIPLATELET STRATEGY FOR EMERGENT CAROTID STENTING DURING STROKE THROMBECTOMY: A PATIENT LEVEL META-ANALYSIS WITH META-REGRESSION

Abstract Background and aims Emergent carotid stenting during thrombectomy for tandem occlusions requires antiplatelet therapy, but the best intensity is unclear because clinicians must balance early stent patency against intracranial bleeding. We aimed to compare aggressive versus conservative (aspirin-only) antiplatelet strategies using individual patient data (IPD) from available clinical studies. Methods An IPD meta-analysis was performed using RevMan 5.4 software and random effects model. Outcomes were: day 1 carotid stent patency (open vs occluded), final angiographic reperfusion (TICI/mTICI 2b–3 = successful reperfusion; 2c–3 = near-complete reperfusion), functional outcome (mRS 0–2/≤2 = independence), safety (intracranial hemorrhage (ICH), parenchymal hematoma), and mortality. Meta-regression evaluated possible effect modifiers such as onset-to-puncture time. Results Aggressive therapy significantly improved day 1 stent patency (OR 5.51, 95% CI 2.15–14.07). All the other outcomes were not statistically significant: results numerically favored aggressive therapy for successful reperfusion (TICI/mTICI 2b–3; OR 1.48, 95% CI 0.68–3.22), near-complete reperfusion (TICI/mTICI 2c–3; OR 1.30, 95% CI 0.74–2.30), and functional independence (OR 1.57, 95% CI 0.88–2.82), while ICH numerically favored conservative therapy (OR 0.75, 95% CI 0.45–1.26). Symptomatic ICH (OR 1.12, 95% CI 0.52–2.40), and mortality (OR 1.29, 95% CI 0.40–4.19) did not differ significantly. Meta-regression showed that onset-to-puncture time did not modify patency effects (p 0.994). Conclusions Our IPD meta-analysis showed that aggressive antiplatelet strategies were associated with significantly higher early carotid stent patency, while differences in reperfusion, functional outcomes, bleeding, and mortality were inconclusive. Further studies are needed to confirm these findings. Conflict of interest Amr Elrosasy: nothing to disclose, Obai Yousef: nothing to disclose Figure 1 - belongs to Results Figure 2 - belongs to Results Figure 3 - belongs to Results Figure 4 - belongs to Results Figure 5 - belongs to Results