ABSTRACT NUMBER: ESOC2026A1493 CAROTID ATHEROSCLEROTIC BURDEN, CEREBRAL VENOUS DRAINAGE, AND FUNCTIONAL OUTCOME AFTER ISCHEMIC STROKE

Abstract Background and aims While carotid atherosclerosis is an established stroke risk factor, its influence on cerebral venous drainage and functional recovery remains insufficiently understood. This study investigated relationships between carotid plaque characteristics, venous hemodynamics, and 90-day functional outcome. Methods This prospective cohort included 120 consecutive patients with acute ischemic stroke and ipsilateral carotid stenosis ≥70%. Carotid plaque morphology was assessed using duplex ultrasound. Cerebral venous drainage was evaluated by contrast-enhanced MR venography within 72 hours. Functional outcome was measured using modified Rankin Scale (mRS) at 90 days by blinded assessors. Results Patients with unstable or high-burden carotid plaques demonstrated significantly reduced venous outflow velocities (19.8±4.3 vs. 23.6±4.7 cm/s, p=0.01) and enlarged venous sinus diameters (p<0.05). Impaired venous drainage strongly associated with unfavorable outcome (mRS≥3) at 90 days (62% vs. 38%, p=0.004). Multivariate regression analysis, adjusting for age, baseline NIHSS, infarct volume, and collateral status, identified reduced venous flow velocity as an independent predictor of poor outcome (OR 2.6, 95% CI 1.4–4.9, p=0.003). Conclusions Carotid atherosclerotic burden significantly impacts cerebral venous drainage, which independently predicts poorer functional recovery. Combined arterial and venous hemodynamic assessment may substantially improve prognostic stratification and guide individualized treatment strategies in stroke patients. Conflict of interest Fayzullo Mallayev: nothing to disclose