ABSTRACT NUMBER: ESOC2026A1868 EARLY NEUROLOGICAL PROGRESSION IN ANTERIOR CHOROIDAL ARTERY INFARCTS AND ASSOCIATED FACTORS

Abstract Background and aims The clinical course and prognosis of anterior choroidal artery (ACHA) infarctions remain poorly defined. Early neurological deterioration (END), defined as an increase of four or more NIHSS points or two or more motor NIHSS points during hospitalization, represents key window for intervention. This study aims to identify biomarkers of END in ACHA infarcts. Methods We conducted a retrospective descriptive study including patients admitted to the neurovascular unit of Sahloul Hospital, Tunisia, for ACHA ischemic stroke, over a 33-month period.Clinical and radiological data were collected. Results Ninety patients were included (mean age 61.8 ± 0.5). END occurred in 18.8% (n = 17). Progressors had a significantly higher NIHSS score at discharge than non-progressors (8 ±3 vs. 4 ±3; p <0.001). Diabetes was the strongest predictor of END (p =0.026; OR =4.18). Radiologically, non-lacunar infarcts >15 mm were more frequent among progressors (p =0.064; OR=3.06) same as ipsilateral internal carotid stenosis (p=0.165, OR=2.908). In multivariate analysis, moderate-to-severe leukoaraiosis (Fazekas ≥ 2) independently predicted END (p= 0.04; OR =5.8), while hypertension was independently associated with a lower risk of progression (p=0.017; OR=0.124). Neither intravenous thrombolysis (p=0.160) nor clopidogrel loading (600 mg; p =1.000) reduced progression. Conclusions END occurs in nearly one-fifth of ACHA infarcts and is associated with worse outcomes. Diabetes is the main clinical predictor, while larger non-lacunar infarcts and advanced leukoaraiosis are key radiological markers. These findings support early risk stratification and closer monitoring, and suggest the need for further therapeutic studies. Conflict of interest Lina Bouafia : Nothing to disclose, Houssem Slimen : Nothing to disclose, Emna Jarrar : Nothing to disclose, Ahmed Mili : : Nothing to disclose, Khaoula Jeamii: : Nothing to disclose, Anise Hassine : Nothing to disclose, Salma Naija : Nothing to disclose, Sana Ben Amor : Nothing to discloseL