ABSTRACT NUMBER: ESOC2026A548 ENDOVASCULAR STROKE THROMBECTOMY FOR PATIENTS WITH ACTIVE ONCOLOGIC ILLNESS AIMING AT RECOVERY: THE ESPOIR STUDY

Abstract Background and aims In patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) and concomitant cancer, endovascular thrombectomy (EVT) achieves recanalization rates comparable to those in non-cancer patients, yet mortality and 3-month outcomes remain poor. This is likely because many patients have advanced malignancy. This study aimed to identify an appropriate outcome measure for EVT effectiveness and to compare EVT with medical management (MM) in this population. Methods This multicenter retrospective observational study included AIS patients admitted within 24 hours of onset between 2018 and 2024, who had LVO, NIHSS ≥6, ASPECTS ≥3 (or pc-ASPECTS ≥6), and active solid malignancy. Active malignancy was defined as newly diagnosed within 6 months, receipt of cancer treatment within 6 months before stroke, or evidence of recurrence, progression, or metastasis at stroke onset. Clinical characteristics and outcomes at discharge and 90 days were compared between EVT and MM groups. Results A total of 1,127 patients from 96 centers were enrolled (EVT, n=922; MM, n=205). After adjustment for prognostic factors, EVT was associated with a higher rate of favorable functional outcome (mRS 0–2 or no worse than pre-stroke mRS) at discharge compared with MM (26.3% vs 14.7%; adjusted OR 1.74, 95% CI 1.02–3.00; P=0.04). No significant differences were observed in 90-day outcomes or mortality. These findings were consistent after propensity score matching. Conclusions EVT was associated with improved functional outcomes at discharge compared with MM alone in patients with LVO and active malignancy, suggesting discharge outcome as an appropriate endpoint for future randomized trials. Conflict of interest All authors; nothing to disclose