ABSTRACT NUMBER: ESOC2026A1546 ENDOVASCULAR THERAPY IMPROVES CLINICAL OUTCOMES IN PATIENTS WITH ACUTE ISCHEMIC STROKE CAUSED BY ISOLATED M2 OCCLUSION: REAL-WORLD EXPERIENCE FROM THE RES-Q REGISTRY

Abstract Background and aims Indication for EVT in acute ischemic stroke (AIS) caused by middle cerebral artery M2 segment (MCA/M2) occlusion remains controversial. The aim was to compare clinical outcomes in these patients treated with IVT, EVT, and IVT+EVT. Methods In an observational multicenter cohort study, we analyzed data from AIS with causative MCA/M2 occlusion treated with IVT, EVT, and IVT+EVT, prospectively collected in the RES-Q registry in the Czech Republic (2022–2024). Clinical outcomes were assessed using utility-weighted 3-month mRS and 3-month mortality. Baseline differences were adjusted using multivariable ordinal regression for utility-weighted 3-month mRS and multivariable logistic regression for 3-month mortality, including age, sex, NIHSS, pre-stroke mRS, and onset-to-treatment time. Missing 3-month outcomes were handled using multiple imputation. Results IVT group consisted of 520 (248 males; median age 74 [65–82] years), EVT group of 223 (117 males; median age 73 [61–81] years), and IVT+EVT group of 321 patients (163 males; median age 73 [64–79] years). Adjusted utility-weighted 3-month mRS was significantly better in the IVT+EVT versus IVT group (OR 1.26, 95% CI 1.05–1.51), and in the IVT+EVT versus EVT group (OR 1.31, 95% CI 1.07–1.59); there was no difference between EVT and IVT groups. There were no differences in 3-month mortality between groups. Conclusions The addition of EVT to IVT was associated with better 3-month clinical outcomes compared with IVT alone in patients with AIS due to MCA/M2 occlusion. Conflict of interest Roman Herzig: Supported by STROCZECH (LM2023049), MH CR (DRO—UHHK 00179906), and Charles University, CR (Cooperatio Program–NEUR). Szabolcs Szabó: Supported by Charles University, CR (Cooperatio Program–NEUR). Geraldo Neto: Supported by STROCZECH (LM2023049). Robert Mikulík: Supported by STROCZECH (LM2023049).