ABSTRACT NUMBER: ESOC2026A559 IMPACT OF A COMPREHENSIVE 72-HOUR STROKE UNIT PROTOCOL IMPLEMENTATION ON OUTCOMES AFTER MECHANICAL THROMBECTOMY: A PRE–POST OBSERVATIONAL STUDY

Abstract Background and aims Although mechanical thrombectomy (MT) represents the key treatment for acute ischemic stroke due to large vessel occlusion, early management in Stroke Unit may significantly influence patient outcomes. We evaluated the impact of implementing a comprehensive and standardized 72-hour Stroke Unit protocol on clinical outcomes in patients treated with MT. Methods We performed a single-center, observational pre–post cohort study including consecutive patients undergoing MT. The intervention group contain patients admitted after implementation of a structured Stroke Unit protocol, including systematic Fever, Sugar and Swallowing (FeSS) management, standardized neurological monitoring according to the SNOBS scale, continuous cardiological and respiratory monitoring, early multidisciplinary rehabilitation and the use of bedside visual cues (“Arrow Project”, Figure 1) to facilitate team work and communication during the first 72 hours. Results Fifty-nine patients were included (28 in the intervention group and 31 in the control group), with comparable baseline characteristics. After protocol implementation, a significantly higher proportion of patients achieved good functional outcome at 3 months (modified Rankin Scale 0–2 = 53.8% vs 27.5%, p < 0.05). Moreover, the intervention group showed higher home discharge rates (42.8% vs 19.3%, p < 0.05) and fewer in-hospital infections (10.7% vs 45%, p < 0.01). No significant reduction of in-hospital and 3-month mortality is observed. Conclusions These findings support the implementation of a structured Stroke Unit care pathway as an integral part of post-thrombectomy management, with potential benefits in care consistency beyond reperfusion therapies. Further studies are needed to confirm these findings, defining the contribution of individual protocol components. Conflict of interest A. Davoli: nothing to disclose. S. Vagnarelli: nothing to disclose. P. Santalucia: nothing to disclose. A. Salerno: nothing to disclose. Figure 1 - belongs to Methods