ABSTRACT NUMBER: ESOC2026A1532 RETHINKING MINOR STROKE MANAGEMENT:DIRECT DISCHARGE HOME OF ISCHAEMIC STROKE PATIENTS AS A SAFE ALTERNATIVE TO STROKE UNIT ADMISSION

Abstract Background and aims Traditionally, all patients with acute stroke seen in an emergency department are admitted to an inpatient care setting. However, for patients with a minor ischaemic stroke without an indication for reperfusion therapy or inpatient rehabilitation, admission may not always be necessary. Since early 2022, patients presenting with a minor ischaemic stroke at a tertiary care hospital have been given the option for direct discharge to their home environment after shared decision-making. This retrospective cohort study aimed to evaluate whether discharging patients directly is safe. Methods We analysed patients with minor ischaemic strokes who were discharged directly between February 1st, 2022, and July 1st, 2024. Inclusion criteria included a clinical diagnosis of acute ischaemic stroke (NIHSS <3), and direct discharge home. Exclusion criteria were the need for reperfusion therapy, large vessel occlusions on imaging, and comorbidities requiring hospitalization. The primary outcome was the occurrence of a severe cerebrovascular adverse event within 48 hours after discharge; defined as a progressive stroke or haemorrhagic transformation with a NIHSS increase of at least two points, a recurrent ischaemic stroke requiring reperfusion therapy, or death. Secondary outcome included stroke unit admissions at 48 hours. Results A total of 166 patients were included, with four patients (2,4%) requiring stroke unit admission within 48 hours due to a progressive stroke. No other severe cerebrovascular adverse or treatment changes were observed. Conclusions Direct discharge home appears to be a safe alternative for selected minor ischaemic stroke patients. Further studies are needed to assess the safety and feasibility on a broader scale. Conflict of interest Simon van Sinderen: nothing to disclose