ABSTRACT NUMBER: ESOC2026A1336 IMPACT OF IMAGING MODALITY ON OUTCOME OF PATIENTS PRESENTING WITH LARGE ISCHEMIC CORE

Abstract Background and aims The benefit of mechanical thrombectomy for large core strokes are proven. However, imaging modalities used in studies were variable. In this study, we aimed to evaluate the impact of imaging modality on outcome of patients with large core. Methods We retrospectively analyzed patients who underwent MT. Patients with ASPECTS score <6 on CT or MRI were included. Clinical outcomes were evaluated based on NIHSS scores at onset, 24-hour, and 90-day mRS scores. The association between onset imaging modality and clinical outcomes was analyzed. Results A total of 117 patients were included, of whom 47 underwent CT and 70 MRI. Sixty-eight patients (58.1%) presented within 0–6 hours of onset, while 49(41.9%) were late presenters. Successful reperfusion (eTICI 2c–3) was achieved in 83 patients (71%). At 90 days, 22 patients (18.8%) were functionally independent, and 68(58.1%) died. Although patients evaluated with MR had lower 24-hour NIHSS scores than those evaluated with CT (p=0.009), there were no significant differences in 90-day functional independence or mortality (p=0.58 and p=0.17, respectively). Likewise, 90-day mRS scores did not differ by imaging modality in patients with early or late onset. There was no significant difference in mRS scores between patients with right- or left-hemispheric stroke (p=0.41). Patients with first-pass effect in MT demonstrated lower mortality at 90 days (p=0.021). Conclusions Despite potential reversibility of lesions on MRI, no differences in outcomes were observed between CT- and MRI-based evaluation, indicating that clinical and procedural factors may play more prominent role in prognosis. Conflict of interest Sena Aksoy: nothing to disclose, Arsida Bajrami: nothing to disclose, Songül Şenadım: nothing to disclose, Serdar Geyik: nothing to disclose