ABSTRACT NUMBER: ESOC2026YS238 STROKE IN THE EMERGENCY DEPARTMENT: PATIENT AND STROKE CHARACTERISTICS, NEUROIMAGING, TREATMENT AND OUTCOMES IN A TERTIARY STROKE CENTRE

Abstract Background and aims The emergency department (ED) has a crucial role in acute ischemic stroke (AIS) management, but strokes occurring in the ED (EDS) have not yet been investigated. We aimed to describe the clinical characteristics, neuroimaging, acute treatments, and outcomes of AIS in our ED. Methods We analyzed all consecutive AIS from the primary referral area in the Acute-Stroke-Registry-and-Analysis-of-Lausanne (ASTRAL, 1/2003-12/2024). Patient/stroke characteristics, radiological features, revascularisation treatment rates, and 3-months modified Rankin scale distribution were compared first between EDS and other in-hospital strokes (other-HIS), and then between EDS and COS. We used uni- and multivariable logistic regression analyses. Results In 4’919/8’355 consecutive AIS meeting inclusion criteria, we found 59 (1.2%) EDS, 379 (7.7%) other-IHS, and 4’481 (91.1%) COS. When comparing EDS with other-IHS, EDS had less coronary artery disease (ORadj=0.20, 95%-confidence-interval 0.06-0.63) and renal failure (0.16;0.05-0.51), higher acute systolic blood-pressure (1.03;1.02-1.05), higher ASPECTS scores (1.36;1.01-1.82), more revascularization treatments (ORadj=2.24;1.09-4.63) and a potentially better 3-months-outcome (Rankin-shift:ORadj=0.61 (0.36-1.02). When comparing EDS with COS in univariable analysis (multivariable analysis pending), EDS had less sleep-onset stroke (OR=0.24;0.10-0.61), more arterial stenoses/occlusions on imaging (OR=4.55;2.01-10.31), more frequent revascularisation treatments (OR=3.94;2.02-7.7) and a seemingly better 3-months-outcome (OR=0.73;0.63-0.85). Both comparisons yielded higher rates of atherosclerotic stroke mechanism in EDS (p<0.01). Conclusion This retrospective single center analyses show that stroke in the ED is a rare but highly treatable entity which benefit from tighter surveillance, knowledge about atherosclerotic stroke mechanism and readily accessible revascularisation treatments. These factors likely explain their better medium-term outcome. Conflict of interest Carl Manuata Tetaria : nothing to disclose