ABSTRACT NUMBER: ESOC2026A1388 INTRACRANIAL HEMORRHAGE IN PATIENTS UNDERGOING ENDOVASCULAR TREATMENT FOR STROKE DUE TO OCCLUSION OF MEDIUM OR DISTAL VESSELS: INSIGHTS FROM THE DISTAL TRIAL

Abstract Background and aims The DISTAL trial showed no difference in rates of disability or death at 90 days in people with medium or distal vessel occlusion (MDVO) stroke treated with endovascular treatment (EVT) plus best medical treatment (BMT) versus BMT alone. Whether an intracranial hemorrhage (ICH) following EVT in MDVO stroke is associated with a worse outcome is unknown. Methods DISTAL was an open-label, blinded endpoint, randomized trial at 55 hospitals. We randomly assigned (1:1 ratio) people with an isolated MDVO within 24 hours of last seen well to either EVT plus BMT or BMT alone. The primary outcome was disability over the full distribution of the modified Rankin Scale. We studied predictors for ICH in multivariable analysis. Similarly, we assessed predictive variables for the clinical outcome including the interaction term between ICH and treatment arm. Results In 539 patients with 24h imaging available, an ICH was present in 151 (28%). We identified a relationship between EVT with any ICH OR 2.24 (95%CI 1.51-3.36). This association was particularly prominent for subarachnoid hemorrhage, n=69, OR 17.97 (95%CI 7.68-52.73). ). Presence of ICH was associated with worse clinical outcome at 90 days (OR 0.45; 95%CI 0.31-0.64). Conclusions In DISTAL, ICH was more frequent in patients undergoing EVT plus BMT vs BMT. The presence of ICH was associated with worse clinical outcome at 90 days, but we found no evidence that this association differed by treatment arm. Conflict of interest Anna Carels, Robin Lemmens, Jelle Demeestere, Nikki Rommers, Vera Aebichser, Alex Brehm: Nothing to disclose. Marios Psychoios: received research grants from the Swiss National Science Foundation (SNF) and Bangerter-Rhyner Stiftung, received unrestricted grant support from Medtronic Inc., Rapid Medical Inc., Penumbra Inc., Siemens Healthineers AG, Stryker Neurovascular Inc., Phenox GmbH (paid to institution), received speaker fees from Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Rapid Medical Inc., Siemens Healthineers AG (paid to institution) and is Sponsor-PI of the DISTAL Trial, SPINNERS Trial, ICARUS Trial. Urs Fischer: reported research support of the Swiss National Science Foundation and the State Secretariat for Education, Research and Innovation; research support of the Swiss Heart Foundation, the Swiss Brain League and the Horton Foundation; research grants from Medtronic and from Stryker, Rapid medical, Penumbra, Medtronic and Phenox, Boehringer Ingelheim; consultancies for Medtronic, Bayer, Boehringer Ingelheim, Boston Scientific, CSL Behring, Merck, Siemens and Takeda (fees paid to institution). Participation in an advisory board for AstraZeneca (former Alexion/Portola), Auzone, Biogen, AbbVie, Siemens, Corxel (fees paid to institution). Member of a clinical event committee (CEC) of the COATING study (Phenox). Member of the data and safety monitoring committee (DSMB) of the TITAN, RESCIND, LATE_MT, IN EXTREMIS and RapidPulse trials. Past president of the Swiss Neurological Society and president-elect of the European Stroke Organisation.