ABSTRACT NUMBER: ESOC2026A1471 PERFUSION TEMPORAL DYNAMICS PATTERNS IN ISCHEMIC STROKE FOLLOWING ACUTE TREATMENT: DETERMINANTS AND IMPACT ON CLINICAL OUTCOME

Abstract Background and aims Cerebral perfusion parameters in acute ischemic stroke(AIS) could help in predicting response to acute treatments. This study aimed to assess temporal changes of perfusion parameters in routine clinical practice in treated patients with AIS and their impact on clinical outcome. Methods In this retrospective observational study, we included patients with AIS treated with IV thrombolysis and/or mechanical thrombectomy. All patients underwent multimodal CT at baseline and MRI within 24 hrs from symptom onset. We used an AI-based neuroimaging software. At the two timepoints, we measured volumes of total hypoperfusion (TH), ischemic core (IC), and mismatch/ischemic penumbra (M/IP). We evaluated impact of perfusion dynamics on clinical outcomes (modified Rankin score [mRS] and mortality at 3 months). Results Overall, 101 patients with AIS were included (women 40.6%, mean[±SD] age of 72.8[±13.3], median baseline NIHSS 8.50). 71.3% of patients had a perfusion parameter improvement/stability pattern with “Imaging/Clinical Post-treatment TIA” occurring in 22.8% of them. We observed a significant difference between median baseline volumes of TH (from 45.90 to 1.0 ml,p<0.001) and M/IP (from 38.80 to 0 ml,p<0.001) and those assessed in the post-treatment. IC reduction after treatment was found in a high proportion of patients(44.6%). We obtained similar results in the three treatment groups. IC and TH percentage changes were independent predictors of mRS and mortality at 3 months. Conclusions Our study demonstrated that IC as determined with the current neuroimaging tools and parameters could also include salvageable brain tissue areas. Conflict of interest Svetlana Lorenzano: nothing to disclose