ABSTRACT NUMBER: ESOC2026A1299 THROMBUS MAGNETIC SUSCEPTIBILITY: IMPLICATIONS FOR DISTAL EMBOLIZATION RISK DURING ENDOVASCULAR THERAPY

Abstract Background and aims Distal embolization (DE) is a common complication of endovascular therapy (EVT) for acute ischemic stroke. Thrombus magnetic susceptibility quantified by quantitative susceptibility mapping (QSM) may help predict the risk of DE. We investigated the association between thrombus susceptibility on QSM and DE during EVT. Methods Consecutive patients with confirmed intracranial large vessel occlusion undergoing EVT were enrolled from one participating center of the RESCUE-RE registry (Critical Care of Acute Ischemic Stroke After Recanalization). Thrombus magnetic susceptibility was quantified on three-dimensional multi-echo QSM. DE was defined as new downstream occlusions on post-procedural digital subtraction angiography. Multivariable logistic regression was performed to evaluate the association between thrombus susceptibility and DE, adjusting for National Institutes of Health Stroke Scale (NIHSS), stroke etiology, occlusion site, intravenous thrombolysis, and onset-to-groin puncture time. Results Among 61 patients, DE occurred in 18/61 (29.5%). Mean thrombus susceptibility was higher in patients with DE than in those without DE (DE vs non-DE: 0.28±0.11 vs 0.22±0.08 ppm; p=0.029). Higher thrombus susceptibility was independently associated with DE (odds ratio 2.38 per 0.1 ppm; 95% CI 1.04–5.45; p=0.039) after adjustment. Conclusions Thrombus magnetic susceptibility quantified by QSM was independently associated with distal embolization during EVT, suggesting QSM may serve as a pre-procedural imaging biomarker for DE risk stratification. Validation in larger cohorts is warranted. Conflict of interest Conflict of interest: None. Funding: This study was supported by the National Key R&D Program of China (2022YFC2504900). Figure 1 - belongs to Conclusions