ABSTRACT NUMBER: ESOC2026A2263 DEEP MEDULLARY VEIN OUTFLOW AND CLINICAL OUTCOMES IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND SUCCESSFUL ENDOVASCULAR TREATMENT

Abstract Background and aims Cerebral venous outflow is a promising prognostic imaging marker. There is evidence that deep medullary vein (DMV) opacification is associated with clinical outcomes in patients with acute ischemic stroke (AIS) candidates for endovascular treatment (EVT). We tested this hypothesis in EVT patients with successful recanalization. Methods Retrospective study of consecutive patients with AIS at a single institution treated with EVT resulting in successful recanalization after endovascular procedures. Presence of DMV, indicating a favorable profile, was determined by opacification of the medullary vein on mCTA. Our outcomes of interest were: excellent outcome (modified Rankin scale,mRS=0-1), good outcome (mRS=0-2), and a shift on mRS in the ordinal analysis. We investigated independent associations using multivariate logistic and ordinal regression analyses, adjusting for age, sex, baseline stroke severity, early ischemic changes, onset-to-groin time, and intravenous thrombolysis. Results We included 506 patients, mean (±SD) 76.1±12.2 years, 269 (53%) males, median (IQR) NIHSS=18 (12-23), 220 (43%) treated with intravenous thrombolysis, median onset to groin=280 (205-441) minutes. DMO was present in 394 (78%) patients and was more prevalent in those with good collateral status (63% vs 53%, p=0.065). We did not find an association between DMV and excellent outcome; however, DMV doubled the probability of good outcome (OR=2.22;95% CI=1.28-3.85) and was associated with a shift toward better functional outcomes in ordinal regression analysis (cOR=1.93;95%CI=1.24-3.02). Conclusions In AIS patients undergoing EVT, a favourable DMV profile was associated with better functional outcomes. Further investigation may clarify the clinical use and predictive ability of this novel radiological marker. Conflict of interest All Authors: nothing to disclose