ABSTRACT NUMBER: ESOC2026A1488 INCIDENCE AND DETERMINANTS OF EARLY SPONTANEOUS HEMORRHAGIC TRANSFORMATION IN ACUTE ISCHEMIC STROKE: A PROSPECTIVE HOSPITAL-BASED STUDY

Abstract Background and aims Early spontaneous hemorrhagic transformation (HT) is a known complication of ischemic stroke (IS), that remains underreported. We aimed to assess its frequency, clinical and radiological features, associated risk factors, and acute outcomes in a north African population. Methods Consecutive patients with IS were included in this prospective study conducted in the neurovascular unit of Sahloul Hospital, Tunisia, over a 2.5-year period. Early HT was identified on computed tomography or magnetic resonance imaging performed within 7 days of stroke onset. Factors associated with spontaneous HT were analyzed using univariate analyses and multivariate logistic regression. Results A total of 861 IS patients not treated with recanalization therapies were included. HT occurred in 64 patients (7.4%): hemorrhagic infarction in 45 (5.2%) and parenchymal hematoma in 19 (2.2%). HT was lobar in 44 patients (5.1%) and deep in 20 (2.3%). Symptomatic HT occurred in 15 patients (1.7%), including 10 cases of deep HT. Independent predictors were MCA infarction (OR 1.15; p=0.001), higher admission NIHSS (OR 1.01; p=0.001), atrial fibrillation (OR 1.92; p<0.001), reduced estimated glomerular filtration rate (OR 1.35; p=0.016), and Fazekas grade 3 leukoencephalopathy (OR 0.89; p=0.006). HT did not increase short-term mortality (p=0.7). Conclusions Spontaneous HT affected 7.4% of IS patients and was independently associated with atrial fibrillation, MCA infarction, reduced estimated glomerular filtration rate, and higher NIHSS, without acute vital prognosis worsening. Conflict of interest Houssem Slimen : Nothing to disclose, Emna Jarrar : Nothing to disclose, Ahmed Mili : : Nothing to disclose, Khaoula Jeamii: : Nothing to disclose, Rekik Arwa : Nothing to disclose, , Anise Hassine : Nothing to disclose, Salma Naija : Nothing to disclose, Sana Ben Amor : Nothing to disclose