ABSTRACT NUMBER: ESOC2026A901 CAROTID IMAGING AS A KEY ELEMENT IN MODERN ISCHEMIC STROKE EVALUATION

Abstract Background and aims Comprehensive etiological assessment is essential for optimizing management strategies in ischemic stroke. Methods It was performed a retrospective analysis of patients with ischemic stroke recorded in the RES-Q Registry between 1 January 2024 and 31 October 2025. National data from the Republic of Moldova were compared with cases treated at the Institute of Emergency Medicine, a comprehensive stroke center (CSC). Evaluated indicators included carotid artery imaging, detection of carotid stenosis, performance of carotid endarterectomy or stenting for stenosis >70%. Results A total of 6,576 stroke cases were recorded nationally, including 1,783 patients treated at CSC. The mean age was 69.8 years old. Carotid artery imaging was performed substantially more frequently at CSC (90% vs. 40% nationally). The prevalence of carotid stenosis was similar (75% vs. 74%). At CSC, the rate of carotid stenting among patients with symptomatic carotid stenosis >70% was 35%. This relatively low proportion is most likely explained by the fact that a substantial number of patients were either clinically unstable and therefore not suitable for surgery, or underwent the procedure later than two weeks after the ischemic event. Conclusions Systematic use of carotid imaging within a CSC enables optimal etiological evaluation in ischemic stroke. Surgical intervention rates are most likely influenced by individualized patient selection and the timing of clinical eligibility for surgery, rather than by the underlying disease burden, underscoring the importance of timely and structured diagnostic and referral pathways in modern stroke care, in line with the Stroke Action Plan for Europe recommendations for secondary stroke prevention. Conflict of interest Ciobanu Natalia nothing to disclose