ABSTRACT NUMBER: ESOC2026LT48 LT48 - DIRECT VERSUS CONVENTIONAL TRANSFER TO ANGIOGRAPHY SUITE ON FUNCTIONAL OUTCOME IN PATIENTS WITH SEVERE STROKE TREATED WITH THROMBECTOMY (DIRECT ANGIO): A MULTICENTRE, RANDOMISED, CONTROLLED TRIAL

Abstract Background and aims We aimed to assess the effect of DTAS for patients with acute severe neurological deficit highly suggestive of ischemic stroke due to a large vessel occlusion (ASND-LVO). Methods We did an open-label, multicentre, randomised controlled trial performed in 10 comprehensive stroke centres in France. We enrolled adult patients (85 years) with ASND-LVO (unilateral motor deficit with a score 5 plus a cortical symptom with a score 1 based on the NIHSS) admitted within 5 hours of symptom onset. Patients were randomised in (1:1) ratio to DTAS or conventional pathway. The primary outcome was functional independence defined as modified Rankin Scale score 0 to 2 at 90 days in the intention-to-treat population. Results 115 patients (57 in the DTAS and 58 in the conventional group) were randomised. The steering committee permanently stopped the trial for safety reasons. In the ITT analysis, the risk of symptomatic intracranial hemorrhage was increased in the DTAS group compared to the conventional group (5 15% of 34 vs 0 0% of 42; adjusted odds ratio OR 10·2; 95% confidence interval [CI] 1·18-1296). DTAS led to a non-significant lower rate of functional independence (20 36% of 56 vs 22 42% of 53; adjusted OR 0·73; 95% CI 0·32-1·69). Analysis in the modified intention-to-treat (patients with LVO) population yielded similar findings. Conclusions DTAS pathway are associated with an increased risk of symptomatic intracranial hemorrhage without evidence for a beneficial effect on functional outcome. Conflict of interest