ABSTRACT NUMBER: ESOC2026OT35 MECHANICAL THROMBECTOMY FOR LARGE-CORE ISCHEMIC STROKE: OUTCOMES FROM A MULTICENTER RETROSPECTIVE COHORT IN RIYADH, KSA

Abstract Background and aims Mechanical thrombectomy (MT) is established for large vessel occlusion stroke; however, patients with large infarct cores (ASPECTS 0–5 or infarct volume ≥50 mL) were historically excluded from early trials due to concerns about poor outcomes and procedural risk. Recent randomized trials have shown that MT may still provide meaningful benefit in carefully selected large-core patients, yet evidence from Middle Eastern populations remains limited. Given differences in stroke demographics in Saudi Arabia, region-specific data are needed to guide practice. Methods To evaluate functional outcomes in patients with large-core ischemic stroke undergoing MT, compare results with conservatively managed patients, and identify clinical and imaging predictors associated with favorable outcomes in a Saudi cohort. Results This multicenter retrospective observational study includes adults with anterior-circulation LVO and ASPECTS 0–5 or infarct volume ≥50 mL treated between January 2020 and September 2025 at KFSH&RC and KFMC. Patients undergoing MT within 24 hours and with available 90-day mRS are included; posterior-circulation strokes and incomplete records are excluded. Outcomes assessed include 90-day functional status, mortality, and hemorrhagic complications. Comparative and multivariable analyses will explore treatment effect and predictors of benefit. Estimated sample size: 53 patients. Conclusions Primary outcome: 90-day modified Rankin Score. Secondary outcomes: mortality, symptomatic intracranial hemorrhage, procedural complications, and predictors of favorable outcome. Conflict of interest