11th European Stroke Organisation Conference Abstracts – 21-23 May 2025,Helsinki,Finland: Late Breaking Abstracts

E-Posters - LATE BREAKING ABSTRACTS

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P2628 - ESOC2025-LB-106

THROMBOLYSIS WITH TENECTEPLASE IN ACUTE ISCHEMIC STROKE PATIENTS TAKING DIRECT ORAL ANTICOAGULANTS (PASSION) - A MULTICENTER RANDOMIZED PLACEBO-CONTROLLED CLINICAL TRIAL

Eckhard Schlemm¹, Anna Suling¹, Götz Thomalla

¹University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg, Germany

Background: Ischemic stroke is a major cause of disability in adults. Intravenous thrombolysis is a safe and effective reperfusion therapy that reduces disability and improves quality of life. Most patients on direct oral anticoagulants are not currently eligible for intravenous thrombolysis due to a lack of safety and efficacy data. As thrombectomy is only suitable for patients with a large artery occlusion, most stroke patients on DOACs do not receive any acute reperfusion treatment.

Case Report / Trial: PASSION will be a multicenter randomized placebo-controlled clinical trial in Germany. 668 acute ischemic stroke patients on direct oral anticoagulant therapy will be randomized to receive either thrombolysis with tenecteplase 0.25mg/kg bodyweight or matched placebo. Treatment allocation will be masked. PASSION will include patients for whom intravenous thrombolysis would be considered if they were not on direct anticoagulant therapy.

The primary endpoint will be functional outcome (mRS) at 90 days, safety endpoints will include intracranial hemorrhage, major hemorrhage, death or dependency, and mortality.

High impact reason: PASSION will assess the safety and efficacy of thrombolysis in stroke patients taking direct oral anticoagulants. With more than 10% of AIS patients being on anticoagulant treatment, there is currently a large unmet need to provide safe and effective reperfusion therapy to this growing group of patients.

PASSION aims to inform clinical practice. In case of positive results, a safe and effective thrombolytic therapy will become routinely available to stroke patients on direct oral anticoagulant therapy in the future.

Results: The current status of the PASSION trial will be presented.

Disclosure of interest: The trial will be funded by the German Federal Ministry of Education and Research (BMBF) and supported by Boehringer Ingelheim. The authors have nothing to disclose.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P2629 - ESOC2025-LB-107

Safety and Efficacy of Treatment with Early Aspirin Administration Following Intravenous Thrombolysis for Acute Ischemic Stroke (TREND-IVT): A Multicenter, Randomized, Placebo-Controlled Clinical Trial

Wenbo Zhao¹

¹Xuanwu Hospital, Capital Medical University, Beijing, China

Background: Early neurological deterioration (END) following intravenous thrombolysis therapy is a common phenomenon strongly associated with unfavorable outcomes. To evaluate the safety and efficacy of administering 300 mg aspirin within three hours following the initiation of IVT in improving functional outcomes in patients with AIS, compared to standard antiplatelet therapy.

Case Report / Trial: The trial is a multicenter, randomized, placebo-controlled trial conducted in China. In total, 1,184 patients will be enrolled if they are eligible for IVT using Alteplase or Tenecteplase. All enrolled patients will be randomly assigned in a 1:1 ratio to receive either early aspirin antiplatelet therapy within three hours following IVT or standard antiplatelet therapy 24 hours after IVT. Data collection will be performed via a secure internet site with real-time data validation.

The primary outcome is a favorable functional outcome, defined as a mRS score of 0-1 at 90 days. Secondary outcomes include the proportion of patients with mRS scores of 0-1 at 30 days and 0-2 at 90 days; ordinal shift analysis of mRS scores at 90 days; and changes in NIHSS scores. Safety endpoints include symptomatic intracerebral hemorrhage, any intracerebral hemorrhage within 48 hours, systemic bleeding, recurrent stroke or other vascular events, mortality, and other adverse events within 90-day follow-up.

High impact reason: The TREND-IVT trial will evaluate the safety and efficacy of early antiplatelet therapy with aspirin in patients with AIS receiving IVT and may provide a promising strategy for improving the functional outcomes of these patients.

Results: NA

Disclosure of interest: Wenbo Zhao: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2630 - ESOC2025-LB-112

EARLY AND ACCURATE STROKE DETECTION VIA CAROTID MONITORING

Hilla Ben-Pazi¹, Yair Lavi¹, Lior Elmaliach¹, Shady Jahshan², Marc Ribo³, Roni Eichel⁴, Danny Dvir⁴, Hilit Cohen⁵

¹Avertto Medical Ltd, Aderet, Israel, ²galilee medical center, Naharia, Israel, ³val d'Hebron medical center, Barcelona, Spain, ⁴Sharee Zedk medical center, Jerusalem, Israel, ⁵Sheba medical center, Ramat Gan, Israel

Background: Avertto has developed an innovative stroke detection system that utilizes continuous carotid artery monitoring with advanced sensors and AI-driven algorithms. This system aims to provide early alerts for stroke risks, enabling timely intervention to prevent neurological damage. The technology detects changes in carotid stiffness and blood flow, which have been linked to stroke risks. To validate its effectiveness, Avertto conducted a blinded study to assess the system’s performance in a clinical setting.

Case Report / Trial: This blinded study was conducted in high-acuity units across multiple centers, for patients at high risk of stroke, including those undergoing TAVI (Transcatheter Aortic Valve Implantation), cardiac surgery, and those with high-risk TIA or subarachnoid hemorrhage. The study aimed to evaluate the system’s sensitivity and specificity in detecting carotid blood flow changes and its ability to provide early warnings of stroke events. Data was collected from patients monitored using Avertto’s device, and results were compared to clinical outcomes during hospitalization.

High impact reason: This study is significant as it expands the treatment window before clinical symptoms appear. By detecting vascular changes early, the system allows for earlier intervention, potentially reducing stroke severity and improving patient outcomes. This approach could transform stroke care by enabling proactive management of stroke risk.

Results: The blinded study (n=14) yielded promising results, demonstrating a sensitivity of 100% and specificity of 83.33%. The study is ongoing, with additional data expected and will be presented accordingly.

Disclosure of interest: Founder and CEO of Avertto medical Ltd.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.07 - IMAGING - Non acute

P2631 - ESOC2025-LB-149

THE EFFECT OF INTERLEUKIN-6 ON CEREBRAL ARTERIOVENOUS MALFORMATIONS

Sarafroz Erkinova¹, Yoqutxon Madjidova¹

¹Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan

Background: Arteriovenous malformation of the brain (AVM) - a vascular anomaly of the brain. Although the exact mechanisms underlying the development, progression, and rupture of AVMs are unknown, several studies suggest that inflammation plays a significant role in pathogenesis. Interleukin-1 receptor antagonists (IL1RN), interleukin-6 (IL-6), tumor necrosis factor (TNF-a), interleukin-1a, β (IL-1a and IL-1b), and interleukin-8 (IL-8) are examples of inflammatory cytokines that raise the risk of arterial wall damage during AVM and exacerbate existing damage. Additionally, they promote angiogenesis, leukocyte proliferation, endothelial cell migration, and the development of metalloproteinases, which harm blood vessel walls and cause the AVM node to rupture.

Case Report / Trial: The goal of the research was to look into the causal connections between the genetic susceptibility for the development of AVM in Uzbek citizens and the polymorphic variations rs4073, rs16944, rs1800795, rs1800796, and rs4073 of the cytokine genes IL-1a, b, IL-6, and IL-8.

High impact reason: Materials and methods: 76 patients with a diagnosis of cerebral AVM were examined. The control group consisted of 80 residents without AVMs. Polymorphic gene variants were determined by real-time PCR using competing TaqMan probes.

Results: As a result of our study, associative analysis revealed the association of polymorphic allele -174G (rs1800795) of the IL-6 gene with the development of AVM (OR=1.309, CI=[1.026-1.671], p=0.03). In conclusion, the IL-6 –174G polymorphism may be a risk factor for BAVM among Uzbeks. This association was observed after accounting for differences in genetic ancestry.

Disclosure of interest: This is an academic research trial funded by the National Health and Medical Research Council (NIHSS) of Australia. No conflicts declared by all authors in relation to this publication.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 02.01 - INTRACEREBRAL HAEMORRHAGE

P2632 - ESOC2025-LB-159

A RANDOMIZED TRIAL ON HEMODYNAMIC OPTIMIZATION OF CEREBRAL PERFUSION AFTER ENDOVASCULAR THERAPY IN ACUTE ISCHEMIC STROKE

Joan Martí-Fàbregas¹, Juan Alvarez-Cienfuegos², Nicolas Lopez³, Ana Rodríguez-Campello⁴, López Mesonero⁵, Herbert Tejada Meza⁶, Maria del Mar Freijo⁷, Jose Ignacio Tembl⁸, Laura Albert Lacal⁹, Alan Flores¹⁰, Blanca Pardo-Galiana¹¹, Pol Camps Renom¹

¹Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, ²Hospital Universitari Dr. Josep Trueta, Girona, Spain, ³HOSPITAL GENERAL UNIVERSITARIO DR. BALMIS, Alicante, Spain, ⁴Hospital del Mar, Barcelona, Spain, ⁵Hospital Universitario de Salamanca, Salamanca, Spain, ⁶Hospital Universitario Miguel Servet, Zaragoza, Spain, ⁷Hospital de Cruces, Barakaldo, Spain, ⁸Hospital La Fe, Valencia, Spain, ⁹Hospital Universitario Virgen de la Arrixaca, Murcia, Spain, ¹⁰Hospital Universitari Joan XXIII, Tarragona, Spain, ¹¹Hospital Universitario Virgen del Rocío, Sevilla, Spain

Background: After mechanical thrombectomy (MT) less than half of the patients with large vessel intracranial occlusion (LVO) achieve functional independence. Optimization of blood pressure (BP) after MT could improve clinical outcomes by improving cerebral perfusion and preventing cerebral bleeding and edema.

Case Report / Trial: ClinicalTrials.gov Identifier: NCT04892511. Standard BP management will compared with BP targets according to the degree of recanalization, as measured by the TICI (Thrombolysis in Cerebral Infarction) scale after successful MT. Study design: Multicenter Prospective Randomized Open, Blinded End-point (PROBE) study. A total of 814 patients with LVO will be allocated to either receive standard treatment (routine local BP management) or hemodynamic optimization, which includes: 1) BP lowering during the 72 hours following MT with different targets according to the TICI score: Intensive (100-140 mmHg systolic BP) after TICI 2c/3; or moderate (140-159mmHg systolic BP) after TICI 2b; 2) Induced hypertension (with isotonic saline serum and intravenous phenylephrine) to reach the desired target if needed. Primary end-point: Functional outcome assessed by the modified Rankin scale (mRS) score at 3 months by a blinded investigator. We will compare the proportion of patients with favorable (mRS 0-2) vs. unfavorable (mRS 3-6) outcome in both groups (optimized vs. standard control). The OR will be estimated with binary logistic regression.

High impact reason: Protocolised management of BP after MT may improve clinical outcomes.

Results: We expect to have them in 2026. To date, a total of 378 patients have been

enrolled. An interim analysis (march 2024) concluded that the trial can be continued as

planned.

Disclosure of interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this abstract.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 02.01 - INTRACEREBRAL HAEMORRHAGE

P2633 - ESOC2025-LB-195

CAROTID ARTERY STENTING DURING ENDOVASCULAR TREATMENT OF ACUTE ISCHEMIC STROKE (CASES) - A MULTICENTER RANDOMIZED CLINICAL TRIAL

Theodora van Elk¹, Louise Maes^2,3, Anne van der Meij⁴, Paul Nederkoorn⁵, Robin Lemmens^2,3, Maarten Uyttenboogaart¹

¹University Medical Center Groningen - Department of Neurology, Groningen, Netherlands, ²UZ Leuven - Department of Neurology, Leuven, Belgium, ³Department of Neurosciences, KU Leuven, Leuven, Belgium, ⁴University Medical Center Amsterdam - Department of Neurology, Amsterdam, Netherlands, ⁵University Medical Center Amsterdam - Department of Neurology, Amsterda, Netherlands

Background: The optimal management of tandem lesions in acute ischemic stroke patients is unclear. Our aim is to assess the efficacy and safety of immediate carotid artery stenting (CAS) in patients undergoing endovascular treatment (EVT) for intracranial large vessel occlusions (LVOs) and concomitant carotid artery stenosis.

Case Report / Trial: CASES is a phase 3 multicenter randomized clinical trial with open-label treatment, blinded outcome assessment (PROBE design), and non-inferiority design. We aim to include 600 patients with a CT-angiography proven intracranial LVO in the anterior circulation and a severe ipsilateral proximal carotid artery stenosis (>50%) or occlusion of presumed atherosclerotic origin. Patients will be randomized to either immediate CAS during EVT or to EVT and a deferred strategy with carotid endarterectomy (CEA), CAS or medical management alone according to the national guidelines. The primary endpoint is functional outcome at 90 days, assessed with the modified Rankin Scale (mRS). Secondary outcomes include stroke severity measured with the National Institutes of Health Stroke Scale (NIHSS) at 24 hours and 5-7 days and recurrence of ischemic events, carotid re-occlusion, symptomatic intracranial haemorrhage, mortality and the quality of life at 90 days.

High impact reason: This study will provide high-quality randomized data on the efficacy and safety of immediate CAS in patients undergoing endovascular treatment for acute ischemic stroke due to a carotid tandem lesion.

Results: CASES will be conducted in 27 EVT centers in Belgium and the Netherlands. The first patient was included on July 5^th 2023. Currently, 420/600 patients have been randomized in 25 centers.

Disclosure of interest: Dr. Tanaka has no conflicts of interest to disclose.; Dr. Pensato has no conflicts of interest to disclose.; Dr. AlShamrani has no conflicts of interest to disclose.; Dr. Katsanos has no conflicts of interest to disclose.; Dr. Balali has no conflicts of interest to disclose.; Dr. Ray has no conflicts of interest to disclose.; Dr. Kasner has no conflicts of interest to disclose.; Dr. Beyer-Westendorf has received personal honoraria (lectures, advisory boards) and travel support from Bayer, Daiichi Sankyo, Janssen, Sanofi, and Portola/Alexion; and has received institutional research support from Bayer, Daiichi Sankyo, Janssen, LEO, Pfizer, and Portola/Alexion.; Dr. Toni has no conflicts of interest to disclose.; Dr. Xu has no conflicts of interest to disclose.; Dr. Knutsson is an employee of AstraZeneca; Dr. Ladenvall is an employee of AstraZeneca.; Dr. Sharma has received research grants/contracts from Bayer and Bristol-Myers Squibb and has served as a consultant for Bayer.; Dr. Shoamanesh has received research grants/contracts from AstraZeneca, Bayer, the Canadian Institutes of Health Research, Daiichi Sankyo Company, the Heart and Stroke Foundation of Canada, the National Institutes of Health, Octapharma USA, Inc., and Servier Affaires Medicales; has served on advisory boards for AstraZeneca, Bayer, Daiichi Sankyo Company, and Takeda Pharmaceutical Company; and has served on a data and safety monitoring board for Bayer.; Dr. Demchuk has received honoraria for lectures from AstraZeneca Canada and Novo Nordisk AS; has participated on advisory boards for Hoffmann-La Roche Limited and NovaSignal; has served on data and safety monitoring committees for Lumosa and Philips; holds stock and a patent (Patent number: 10373718; 2023039659; 20230277151) for Circle NVI.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 02.01 - INTRACEREBRAL HAEMORRHAGE

P2634 - ESOC2025-LB-199

EARLY VERSUS DELAYED ANTICOAGULATION IN ACUTE ISCHAEMIC STROKE: PRE-SPECIFIED FUNCTIONAL, COGNITIVE AND PATIENT-REPORTED OUTCOMES OF THE OPTIMAS RANDOMISED CONTROLLED TRIAL

Philip Nash¹, Hakim-Moulay Dehbi², Norin Ahmed², Sue Massingham², Amalia Ndoutoumou², Tishok Vanniyasingam², Nicholas Freemantle², David Werring¹

¹Stroke Research Centre, UCL Queen Square Institute of Neurology, Department of Neuroradiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom, ²Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom

Background: It is uncertain whether the timing of DOAC initiation in acute ischaemic stroke with atrial fibrillation affects functional, status, cognition and patient-reported quality of life.

Case Report / Trial: OPTIMAS was a randomised, parallel-group, open-label trial with blinded outcome assessment. Participants were randomised 1:1 to early (⩽4 days) or delayed (days 7-14) DOAC initiation. Sites collected data on functional status (using the modified Rankin Score, mRS), cognition (measured with the telephone Montreal Cognitive Assessment, tMoCA) and patient-reported outcomes (measured with the Patient-reported Outcomes Measurement Information System-10, PROMIS-10) at 90-day follow-up. We investigated these outcomes according to treatment allocation using mixed effects linear and logistic regression models.

High impact reason: We found no evidence that the timing of DOAC initiation affects functional status, cognition or patient-reported physical or mental health outcomes after acute ischaemic stroke with atrial fibrillation.

Results: 3081 participants (mean age 78.3, 44.8% female) were included; 555 (30.6%) had a good functional outcome (mRS 0-1) in the early initiation group and 544 (30.1%) in the delayed group. Compared to delayed initiation, the adjusted risk difference for good functional outcome in the early group was -0.004 (CI -0.036 to +0.027). There were no significant differences in the follow-up cognitive assessments or patient-reported outcomes between the study groups. In the early compared to delayed group the adjusted mean difference for tMoCA scores was -0.148 (CI -0.551 to +0.225) and for the PROMIS-10 physical and mental health scores the differences were -0.022 (CI -0.288 to +0.254) and -0.082 (-0.373 to +0.209), respectively.

Disclosure of interest: Unrestricted funding on behalf of CONTRAST from Penumbra Inc, and Promising Care funding of National Health Care Institute and ZonMw (202138368). Funding sources are not involved in study design, data collection, statistical analyses, or writing.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.07 - IMAGING - Non acute

P2635 - ESOC2025-LB-237

ACUTE STROKE MANAGEMENT IN INTENSIVE CARE UNITS. INCLUDING FESS PROTOCOL

Asel Kerimkulova¹

¹National hospital, Bishkek, Kyrgyzstan

Background: Acute management of stroke in the intensive care unit (ICU) poses significant challenges, particularly in resource-limited settings. The FeSS (Fever, Sugar, Sip) protocol is an evidence-based approach. This study evaluates the implementation of the FeSS protocol in the ICU of the National Hospital under the Ministry of Health of the Kyrgyz Republic, focusing on its impact on clinical outcome.

Case Report / Trial: The FeSS protocol was implemented as part of a quality improvement initiative in the ICU. Outcome data for stroke patients were collected for six months, comparing results before and after implementation. The main outcome measures included infection rates, hypoglycemia, and aspiration pneumonia. A total of 231 stroke patients were included in the study: 163 with ischemic stroke and 68 with hemorrhagic stroke, with a mean age of 64 years.

High impact reason: The FeSS protocol had a positive impact on the quality of care of stroke patients in the intensive care unit of the National Hospital in Kyrgyzstan. Implementation of evidence-based protocols improved clinical outcomes, including reduced mortality, better glycemic control, and fewer complications. These results suggest that adoption of such protocols in resource-limited settings is both feasible and effective. Results: Implementation of the FeSS protocol resulted in several key improvements:

Results: Reduction in mortality: A comparative 6-month analysis in 2021 and 2022 showed a reduction in mortality from 12.0% in 2021 to 7.8% in 2022, reflecting a 4.2% reduction in overall mortality. • Glycemic control: Achieved in 90% of patients, within the target range. • Fever management: Compliance• improved by 75%.

Disclosure of interest: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P2636 - ESOC2025-LB-311

RADIOMICS ANALYSIS OF ONSET TIME IN ACUTE ISCHEMIC STROKE PATIENTS WITH DWI-FLAIR PARTIAL MISMATCH

Yang Du¹, Xin Ding¹

¹Chengdu Second People's Hospital, Chengdu, China

Background: Early reperfusion therapy, such as thrombolysis, is critical for improving outcomes in patients with acute ischemic stroke (AIS). However, determining eligibility for treatment can be challenging, especially when the precise stroke onset time is unclear. In such cases, the presence of a DWI-FLAIR mismatch on brain imaging is a crucial factor considered for potential treatment.

Case Report / Trial: This retrospective study analyzed AIS patients with DWI-FLAIR partial mismatch who visited a tertiary hospital in Southwest China between November 2017 and November 2023. Radiomic features were extracted from DWI and FLAIR sequences. Significant features were identified, and a binary logistic regression model was constructed to predict whether patients were within the thrombolysis time window (TSS ⩽ 4.5 hours).

High impact reason: Current guidelines lack specific treatment recommendations for patients with partial FLAIR hyperintensity, a subtype of DWI-FLAIR mismatch. This study aimed to investigate the potential of radiomic features extracted from DWI and FLAIR images to predict the time since stroke onset (TSS) in AIS patients with partial FLAIR hyperintensity.

Results: A total of 60 AIS patients were included. The binary logistic regression model demonstrated good performance in predicting TSS, with an AUC of 0.899. Feature analysis revealed that mean lesion signal intensity and other characteristics were highly correlated with TSS.

Disclosure of interest: Nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 03.03 - PROGNOSIS AND OUTCOME AFTER STROKE

P2637 - ESOC2025-LB-314

IMAGING BIOMARKERS FOR RADIOLOGICAL PROGRESSION AND DELAYED THROMBECTOMY ELIGIBILITY

John Holden¹, Wazim Izzath¹, Sharin Singh¹, Finn Begbie¹, Keith Muir¹

¹Queen Elizabeth University Hospital, Glasgow, United Kingdom

Background: Mechanical thrombectomy (MT) is effective within 24 hours of onset based on imaging selection. Patients presenting when MT is unavailable may be eligible for delayed thrombectomy. We describe biomarkers for progression in patients considered for delayed thrombectomy.

Case Report / Trial: In a single centre retrospective observational dataset, we selected patients with anterior circulation LVO who presented outwith times of MT service and underwent repeat imaging for consideration of delayed MT. CT, CTA and CTP were reviewed from presentation and repeat. Volumes of ischaemic core (rCBF <30%), tissue ischaemia (Tmax>6s) and Hypoperfusion Index (volume Tmax>10s/Tmax>6s) were measured by RAPID. ASPECTS was determined by consensus between 3 investigators. We undertook multivariable regression modelling for change in ASPECTS, and whether MT was undertaken.

High impact reason: Between March 2023 and April 2024, 104 underwent MT. 39 patients were identified as LVO on presentation CTA when MT was unavailable (age 67±12, median NIHSS 18). Such patients underwent repeat imaging median 11 (7.5) hours later. 19 underwent MT, 12 were unsuitable due to extensive infarction, 8 recanalised without thrombectomy. Delayed MT was not associated with ASPECTS change, thrombolysis, hypoperfusion index, core or ischaemic tissue volumes. ASPECTS change was associated with baseline core volume (p<0.001). Fulfilling DEFUSE-3 CTP criteria on repeat imaging was associated with baseline penumbra volume (p=0.004) and change in penumbra volume (p=0.004).

Results: In a setting of limited hours of MT, around 50% remained eligible for deferred thrombectomy. Median change in ASPECTS score was 1pt. Baseline penumbra volume was associated with meeting DEFUSE-3 criteria on deferred imaging.

Disclosure of interest: no

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 05.02 - SECONDARY PREVENTION

P2638 - ESOC2025-LB-323

RESCUE STENTING FOR REFRACTORY VERTEBRO-BASILAR ARTERY OCCLUSION: A SINGLE CENTER EXPERIENCE

Jae Ho Kim¹

¹Chosun University Hospital, Gwang ju, South Korea

Background: Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of ischemic stroke, and the prevalence is reported to be up to 50% in Asia. Our aim is to evaluate the clinical efficacy and safety of angioplasty and stenting in refractory vertebra-basilar artery (VBA) stenosis.

Case Report / Trial: Between July 2016 and December 2022, we enrolled the patients who underwent mechanical thrombectomy due to acute occlusion of VBA and classified into 2 groups; ICAS related occlusion group and non-ICAS occlusion group. And we divided the ICAS-realted occlusion group into percutaneous transluminal angioplasty and stenting(PTAS) and non-PTAS groups.

High impact reason: The optimal management of ICAS in the hyperacute setting in patients presenting with LVO remains unclear. In addition, most of the previous studies have been conducted on the anterior circulation, and studies on the posterior circulation are rare.

Results: Seventy-eight patients with acute occlusion of VBA were enrolled in this study. Among 952 patients of entire mechanical thrombectomy of large vessel occlusion. (78/952, 8.2%) ICAS-related occlusion group was 51 patients (65.4%), while non-ICAS occlusion group was 27 (34.6%). Rescue angioplasty and/or stenting were performed in 39 patients (39/51, 76.5%). ICAS-related occlusion group had more hypertension and diabetes and less atrial fibrillation than non-ICAS occlusion group significantly. The good clinical outcomes at three months with the above two mRS were not significantly different between PTAS and non-PTAS group (13/39 (33.33%) vs. 3/12 (25%), p=0.590). The mortality rate (8/39, 20.51% vs. 5/12, 41.67%, p=0.145) and sICH (6/39, 16.66% vs. 2/12, 16.67%, p=0.916) were not significantly different.

Disclosure of interest: SCJ has received research support from Jansen, BMS, and AstraZeneca; GJH reports personal honoraria outside the submitted work from the American Heart Association (Associate Editor, Circulation), Bristol Myers Squibb (Steering Committee, AXIOMATIC-SSP trial of milvexian [factor XIa inhibitor] for secondary stroke prevention) and Janssen (Co-chair, Executive Committee, Librexia Stroke trial of milvexian for secondary stroke prevention).

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P2639 - ESOC2025-LB-337

LACUNAR LSA SIGN, AN ANGIOGRAPHIC MARKER OF REPERFUSION HEMORRHAGE DURING MECHANICAL THROMBECTOMY

Apratim Chatterjee¹

¹CLINICAL LEAD STROKE AND NEUROINTERVENTION, MANIPAL HOPSITALS, KOLKATA, India

Background: Symptomatic intracranial bleed is one of the deadliest complication of reperfusion following mechanical thrombectomy.Early angiographic indication if any of active acute reperfusion hemorrhage during mechanical thrombectomy might help in early prediction, measures and intervention to prevent further bleed and early neurosurgical intervention for salvage if required.We propose one such radiological angiographic sign “lacunar lsa sign”as the marker for acute active reperfusion bleed during mechanical thrombectomy.

Case Report / Trial: A total of ten patients who underwent thrombectomy over a period of two years in a stroke centre operated by trained neurointerventionalist showed this angiographic sign while performing mechanical thrombectomy even with a first pass TICI 3 recanalisation.

Immediately the procedure was terminated and Computed Tomographic scan of brain revealed evidence of reperfusion bleed correlating with the areas of dye extravasation.

High impact reason:

Identification during the thrombectomy procedure may warn the operator of reperfusion bleed and early measures may be taken to prevent furthger damage which may include bp control or lowering,

Coiling or closing the leaking vessel or even compression of the reperfused carotid, immediate ct brain aborting the procedure should be done with urgent decompression by neurosurgery if mass effect is found.

Results: “Lacunar Lsa Sign” is proposed by the authors as the early angiographic marker of reperfusion bleed during mechanical thrombectomy and can help in early damage control and prognostication.

Disclosure of interest: The authorship declare no direct conflicts related to this publication.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 05.02 - SECONDARY PREVENTION

P2640 - ESOC2025-LB-366

TYG INDEX EFFECT ON FIRST PASS RECANALISATION IN ACUTE ISCHEMIC STROKE

Sennur Delibas Kati¹, Ender Uysal², Merve Gürsoy Hasoğlan¹

¹Antalya Training and Research Hospital Neurology, Antalya, Türkiye, ²Antalya Training and Research Hospital Radiology, Antalya, Türkiye

Background: Stroke is one of the most disabling disease for the society. The inflammatory process during acute stroke seems to be related with the first pass recanalisation effect and better outcome. Normal Triglycerid glukoz index (TyG index) is one of those markers which can have a positive effect on first pass recanalisation.

Case Report / Trial: 76 patients are involved in this study. We prospectively analysed the TyG index in those patients.

High impact reason: The first pass effect on mRs and better outcome is accepted as a fact after precious studies in this field. However sometimes more passes needed and this seems to be related with worsened outcome. High TyG index levels are found to be related with cardiovasculary events such as MI and other vasculary diseases. Higher levels of TyG index seems to be related with inflammation and vasculary events.

Results: Normal TyG index levels are related with first pass effect and this is statistically significant. Higher levels of TyG levels indicate poor outcome because of the number of passes.

Disclosure of interest: The study is supported by a grant from the Netherlands Organisation for Health Research and Development (ZonMw).

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.05 - NEUROINTERVENTION

P2641 - ESOC2025-LB-406

SAFETY AND EFFICACY OF INTRA-ARTERIAL TENECTEPLASE FOR NON-COMPLETE REPERFUSION OF INTRACRANIAL OCCLUSIONS (TECNO)

Johannes Kaesmacher¹, Adnan Mujanovic¹, Seraina Beyeler, Morin Beyeler², Daniel Strbian³, Mira Katan⁴, Pasquale Mordasini^1,5, Zsolt Kulcsar⁶, Marios Psychogios⁷, Mikael Mazighi⁸, Götz Thomalla, Robin Lemmens⁹, Jan Gralla¹, Urs Fischer

¹Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland, ²Department of Neurology, University Hospital Bern Inselspital, University of Bern, Bern, Bern, Switzerland, ³Department of Neurology, HUS Helsinki University Hospital, Helsinki, Finland, ⁴Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland, ⁵Department of Diagnostic and Interventional Neuroradiology, Cantonal Hospital St. Gallen, St.Gallen, Switzerland, ⁶Department of Neuroradiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland, ⁷Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland, ⁸Department of Neurology, Hospital Lariboisière, University of Paris, Paris, France, ⁹Department of Neurology, University Hospitals Leuven, University of Leuven, Leuven, Belgium

Background: Despite improvements in reperfusion quality, still 40% of acute ischemic stroke (AIS) patients show non-complete reperfusion after mechanical thrombectomy (MT). Recent studies showed that administration of intra-arterial (IA) thrombolytics may improve final reperfusion grades after incomplete MT. The TECNO trial aims to evaluate the safety and efficacy of IA tenecteplase (TNK) in AIS patients with incomplete reperfusion and residual peripheral occlusions after MT.

Case Report / Trial: TECNO is an international multicenter clinical trial randomizing 156 patients to IA TNK or best medical treatment arm (1:1). Main inclusion criteria is incomplete reperfusion (Thrombolysis in Cerebral Infarction, TICI<3) after MT for initial target occlusions of ICA, M1 or M2. For inclusion, the residual occlusions need to be rated as not mechanically amendable by the treating physician. Primary efficacy outcomes are early and late reperfusion, defined as reperfusion improvement on angiography imaging 25 min after randomization and complete reperfusion on the 24h perfusion MRI, respectively.

High impact reason: There is no high-level evidence on the immediate and delayed evaluation of incomplete reperfusion after IA lytics are given on top of MT. Prior trials have reported clinical endpoints, while the reperfusion effect of IA remains unknown. This trial aims to provide information on the discrepancy between clinical and imaging outcomes, which was not addressed by prior randomized clinical trials.

Results: Recruitment began in March 2023 and will continue until December 2026. By February 2025, 30 patients have been enrolled. Over 50 sites in Switzerland, Belgium, Germany, Finland, Austria, the Netherlands and Portugal will participate in this randomized clinical trial.

Disclosure of interest: The authors declared no conflicts of interest with respect to research, authorship and/or publication of this article.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 05.02 - SECONDARY PREVENTION

P2642 - ESOC2025-LB-415

An update of results from the multicentric, randomized study of sovateltide (Tycamzzi^®) to treat acute cerebral ischemic stroke patients

Anil Gulati¹, Sikandar Adwani², Pamidimukkala Vijaya³, Nilesh Agrawal⁴, Tcr Ramakrishnan⁵, Hari Rai⁶, Dinesh Jain⁷, Nagarjunakonda Sundarachary⁸, Andrews Jeyaraj Pandian⁹, Vijay Sardana¹⁰, Mridul Sharma¹¹, Gursaran Sidhu¹², Sidharth Anand¹³, Deepti Vibha¹⁴, Saroja Aralikatte¹⁵, Dhiraj Khurana¹⁶, Deepika Joshi¹⁷, Ummer Karadan¹⁸, Mohd. Shafat Siddiqui¹⁹

¹Pharmazz, Inc., The University of Illinois at Chicago, Midwestern University, Willowbrook, United States, ²Radiant Superspeciality Hospital, Amravati, India, ³Lalitha Super Specialities Hospital Pvt. Ltd., Guntur, India, ⁴New Era Hospital, Nagpur, India, ⁵KG Hospital and Post Graduate Medical Institute, Coimbatore, India, ⁶Hi-Tech Hospital and Trauma Center, Jhansi, India, ⁷Dayanand Medical College and Hospital, Ludhiana, India, ⁸Guntur Medical College & Government General Hospital, Guntur, India, ⁹Christian Medical College & Hospital, Ludhiana, India, ¹⁰Government Medical College and Attached Hospitals, Kota, India, ¹¹Pushpanjali Hospital & Research Centre, Agra, India, ¹²Sidhu Hospital Pvt. Ltd., Ludhiana, India, ¹³Institute of Neurosciences, Kolkata, India, ¹⁴All India Institute of Medical Sciences, New Delhi, India, ¹⁵KLE’s Dr. Prabhakar Kore Hospital & Medical Research Centre, Belagavi, India, ¹⁶Post Graduate Institute of Medical Education & Research, Chandigarh, India, ¹⁷Institute of Medical Sciences, Varanasi, India, ¹⁸Baby Memorial Hospital, Kozhikode, India, ¹⁹Heritage Institute of Medical Sciences, Varanasi, India

Background: The involvement of endothelin-B (ET-B) receptors in neurogenesis has provided a target for treating acute cerebral ischemic stroke (ACIS). Sovateltide is a highly selective ET-B receptor agonist.

Case Report / Trial: Patients aged 18 to 78 years were enrolled with radiologic confirmation of ischemic stroke and a NIHSS score of ⩾6. Patients receiving endovascular therapy or with intracranial hemorrhage were excluded. Patients were randomized, with 80 patients in the sovateltide and 78 in the control group. Patients received saline or sovateltide (0.3 µg/kg) intravenously within 24 hours of the stroke onset in three doses at intervals of 3±1 hours on days 1, 3, and 6.

High impact reason: Sovateltide received marketing authorization in India and approval from the USFDA to start a Phase 3 trial (NCT05691244).

Results: The patient demographics, NIHSS, ASPECTS, interval between stroke onset and the first treatment dose were similar between the control and the sovateltide groups. More (P=0.0195) patients received thrombolytics in the control group than in the sovateltide group. The co-morbid conditions was similar in the sovateltide and control groups. The number of patients with good neurological outcomes with mRS of 0-2 (p=0.003), NIHSS of 0-5 (p=0.011) and BI scores of 90-100 (p=0.080) at 90 days were more in the sovateltide than in the control group. An absolute increase in the favorable outcome of 22% was observed with sovateltide in patients with mRS of 0 to 2. The adverse events were not related to sovateltide. Sovateltide is safe and improves neurological outcomes in ACIS patients.

Disclosure of interest: Source of Funding: Brazilian Ministry of Health. This trial received donation of medications from Servier. Gisele Sampaio: nothing to disclose related to the Optimal Trial ; Otavio B Berwanger: nothing to disclose related to the Optimal Trial; Karla Santo: nothing to disclose related to the Optimal Trial; Octavio Pontes Neto: nothing to disclose related to the Optimal Trial; Sheila C Martins: nothing to disclose related to the Optimal Trial ; Adriana B Conforto: nothing to disclose related to the Optimal Trial; Flavio D Fuchs: nothing to disclose related to the Optimal Trial; Joao B Andrade: nothing to disclose related to the Optimal Trial; M. Julia Julia Machline Carrion: nothing to disclose related to the Optimal Trial

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2643 - ESOC2025-LB-421

FRAILTY PREDICTS THE PROGNOSIS OF ENDOVASCULAR TREATMENT IN ADULTS AGED 75 AND OLDER WITH ACUTE ISCHEMIC STROKE

Xuehong Chu¹, Chuanjie Wu¹, Wenhua Yu¹, Hongrui MA¹, Xiao Dong¹, Yuanyuan Liu¹, Lina MA¹, Xunming Ji¹

¹Xuanwu Hospital, Capital Medical University, Beijing, China

Background: Stroke is a major global health concern and the leading cause of adult mortality in China. Endovascular treatment (EVT) is increasingly used in older acute ischemic stroke (AIS) patients, but data on the link between frailty and EVT outcomes in those aged ⩾75 years is limited. This study aimed to assess frailty as a prognostic indicator post-EVT in AIS patients aged ⩾75.

Case Report / Trial: This single-center prospective cohort study included 193 AIS patients aged ⩾75 who underwent EVT. Frailty was evaluated using the Clinical Frailty Scale, with the primary outcome being the modified Rankin Scale (mRS) score (0–1) at 3 months post-EVT. Multivariable logistic regression analyzed frailty’s impact on outcomes, highlighting its role in guiding EVT decisions for older AIS patients.

High impact reason: This study addresses a critical gap in understanding frailty’s role in EVT outcomes for older AIS patients. As the global population ages, frailty prevalence among stroke patients rises, yet its impact on EVT outcomes remains underexplored. By showing that frailty and stroke history independently predict poor prognosis, this research emphasizes integrating frailty assessment into EVT decision-making to improve outcomes in this vulnerable group.

Results: Participants’ mean age was 80.34±4.39 years. Factors linked to poor outcomes included frailty, older age, female sex, stroke history, coronary heart disease, more chronic conditions, lower Barthel Index, higher NIHSS scores, elevated fasting glucose, higher neutrophil percentage, higher D-Dimer, and lower hemoglobin. Logistic regression identified frailty and stroke history as independent predictors of poor EVT prognosis in older AIS patients.

Disclosure of interest: This research was funded by the British Heart Foundation. None of the authors have anything to disclose in relation to this work.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 04.05 - STROKE IN THE YOUNG (INCLUDING PAEDIATRIC STROKE)

P2644 - ESOC2025-LB-431

First Line Thrombectomy Technique in Medium Vessel Occlusions

Adam Mierzwa¹, Santiago Ortega-Gutierrez², Leonardo Cruz-Criollo², Jorge Cespedes², Khaled Gharaibeh¹, Mouhammad Jumaa¹

¹Promedica Stroke Network, University of Toledo College of Medicine and Life Sciences, Department of Neurology, Toledo, United States, ²University of Iowa Cerebrovascular & NeuroInterventional Lab, Iowa City, United States

Background: Recent randomized clinical trials evaluating mechanical thrombectomy in medium vessel occlusions demonstrated equivalent rates of excellent functional outcomes. This is in contrast to previous subgroup analyses of the HERMES collaboration and encourages further efforts to delineate specific patient populations or thrombectomy techniques which warrant procedural intervention vs medical management.

Case Report / Trial: This is an analysis of prospectively collected data from two high volume comprehensive stroke centers in the United States. There were 125 acute MeVOs which were delineated based on thrombectomy tecnique (82 ASP vs 53 Solumbra). Primary outcome was functional independence (mRS 0-2) at 90 days. IPW analysis was performed based on clinically significant baseline differences.

High impact reason: Recent randomized clinical trials demonstrated equivalent outcomes between thrombectomy and best medical management; however, this analysis implies that further patient selection and technique could open treatment opportunities for MeVOS.

Results: Patients were generally older (74 years old), white (90%) individuals (Female: 50%) who presented within the acute thrombectomy time window (median 5.5-6.0 hours). Baseline and stroke characteristics were balanced except for higher proportions of dyslipidemia (48.8% vs 15.9%) and baseline disability (26.8% vs 11.4%) in the ASP cohort. At 90 days, patients in the Solumbra cohort were more likely to achieve functional independence outcomes (72.3 % vs 56.8% p = 0.02). An IPW analysis which accounted for clinically significant predicotrs confirmed technique differences (OR 3.01 95% CI 1.79 – 5.14). There were no significant differences in mortality or symptomatic intracranial hemorrhages.

Disclosure of interest: Martino Diana: nothing to disclose Matteo Mordeglia: nothing to disclose Marta Bertamino: nothing to disclose Maria Savina Severino: nothing to disclose Giulia Prato: nothing to disclose Giulia Amico: nothing to disclose Sara Signa: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 09.01 - PRE-HOSPITAL SERVICE ORGANISATION

P2645 - ESOC2025-LB-444

Intravenous Bevifibatide in Large Vessel Occlusion Stroke Before Endovascular Thrombectomy: A Randomized, Double-blind, Placebo-controlled Trial

Erlan Yu¹, Chuanjie Wu¹, Jiaqi Luo¹, Xunming Ji¹

¹Xuanwu Hospital, Capital Medical University, Beijing, China

Background: Bevifibatide is a novel glycoprotein IIb/IIIa receptor antagonist that targets both GPIIb/IIIa and αvβ3 integrin receptors. It exerts a dual antithrombotic effect by inhibiting platelet aggregation and vascular smooth muscle growth, thereby reducing the risk of arterial reocclusion. The efficacy and safety of intravenous bevifibatide in improving functional outcomes for patients with large vessel occlusion stroke undergoing endovascular thrombectomy remain uncertain.

Case Report / Trial: This is a prospective, multi-center, randomized, double-blind, placebo-controlled trial involving patients with acute non-cardioembolic large vessel occlusion stroke undergoing endovascular thrombectomy. Patients will be randomized to the bevifibatide or placebo group at a ratio of 1:1. The primary efficacy endpoint will be the proportion of patients achieving functional independence (defined as a modified Rankin Scale score of 0-2) at 90 days. The primary safety endpoint will be the incidence of symptomatic intracranial hemorrhage within 48 hours.

High impact reason: Results from this trial will indicate whether intravenous bevifibatide is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy.

Results: This trial is currently being prepared and will soon begin.

Disclosure of interest: NS de Ruijter and FCC Kremers: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2646 - ESOC2025-LB-457

A Phase I, Open-Label, Dose-Escalation Study to Evaluate the Safety and Tolerability of Intravenous UMC119-06 in Acute Ischemic Stroke Patients

Jia-Hung Chen¹, Lung Chan¹, Chaur-Jong Hu¹

¹Department of Neurology, Taipei Medical University - Shuang Ho Hospital, New Taipei, Taiwan

Background: Stem cell-based therapies have emerged as a promising treatment for stroke recovery. However, few clinical trials have investigated the therapeutic use of umbilical cord-derived mesenchymal stem cells (UCMSCs) in the management of acute ischemic stroke (AIS).

Case Report / Trial: This open-label, dose-escalation study (NCT04097652) evaluates UMC119-06, a MSCs product derived from human umbilical cord, for the treatment of AIS. The study includes two dosing cohorts: 1×10^6 cells/kg and 5×10^6 cells/kg, with three participants enrolled in each cohort. The primary objective is to assess the safety, tolerability, and maximum feasible dose of UMC119-06, while the secondary objective focuses on evaluating long-term safety and clinical efficacy following a single administration of UMC119-06.

High impact reason: Previous studies using either autologous or allogenic MSCs for the treatment of AIS have mostly failed.This Phase I study provides preliminary evidence regarding the safety and potential efficacy of UMC119-06 in AIS treatment.

Results: Despite the small sample size of six participants, trends toward positive outcomes were observed in the mRS, NIHSS, Barthel Index, and infarct volume. At the end of visit, 4 out of 6 subjects had mRS scores 0-1. 5 subjects had an infarct volume of 0 mL by day 30, while the remaining subject achieved 0 mL by day 90. Changes in biomarkers such as IL-6, TNF-α, VEGF, and HGF suggest a potential impact of UMC119-06 on inflammation, angiogenesis, and tissue repair processes. While the safety evaluation revealed a high incidence of serious adverse events (SAEs) in both dose cohorts, none of the SAEs were directly attributed to UMC119-06.

Disclosure of interest: Dhiraj Khurana: Nothing to Disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 05.02 - SECONDARY PREVENTION

P2647 - ESOC2025-LB-459

Safety and Efficacy of Remote Ischemic Conditioning for Acute Ischemic Stroke Treated with Mechanical Thrombectomy (RECAST-MT): A Multicenter, Randomized, Controlled, Open-label, Blinded Endpoint Trial

Wenbo Zhao¹

¹Xuanwu Hospital, Capital Medical University, Beijing, China

Background: In animal models, remote ischemic conditioning (RIC) can reduce reperfusion injuries and the final infarct size, and it has been demonstrated to be safe and feasible in patients undergoing mechanical thrombectomy (MT). This trial aims to investigate the safety and efficacy of RIC in improving functional outcomes in AIS patients treated with MT, and to explore the optimal treatment duration of RIC.

Case Report / Trial: The RECAST-MT tiral is a multicenter, randomized, controlled, open-label, blinded endpoint trial conducted in China. The trial will enroll patients with AIS due to large vessel occlusion in the anterior circulation and planning to receive MT within 24 hours from the time last known well. All enrolled patients will be randomly assigned in a 1:1:1 ratio to a 14-day RIC group, 30-day RIC group, or control group. All patients will receive MT and the best medical management according to the guidelines.

The primary outcome is the proportion of patients achieving a mRS score of 0-2 at 90 days. Secondary outcomes include dichotomous mRS scores at 90 days, ordinal distribution of mRS scores at 90 days, the proportion of patients with early neurological improvement 24 hours after endovascular procedures, and cerebral infarct volume on the image. All outcomes and serious adverse events are adjudicated by individuals blinded to the treatment allocation.

High impact reason: RECAST-MT will evaluate the safety and efficacy of RIC in patients with AIS treated with MT and may provide randomized evidence on RIC's role in improving the functional outcomes of patients with AIS undergoing MT.

Results: NA.

Disclosure of interest: Seemant Chaturvedi: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 03.02 - LIFE AFTER STROKE

P2648 - ESOC2025-LB-474

Early and Accurate Stroke Detection by Avertto Carotid Monitoring

Hilla Ben-Pazi¹, Shady Jahshan², Hilit Cohen³, Roni Eichel⁴, Marc Ribo⁵

¹Avertto Medical Ltd, Aderet, Israel, ²galilee medical center, Naharia, Israel, ³Sheba medical center, Ramat Gan, Israel, ⁴Sharee Zedk medical center, Jerusalem, Israel, ⁵val d'Hebron medical center, Barcelona, Spain

Background: Early detection of large vessel occlusions (LVOs) is critical for improving stroke outcomes. Avertto™, a novel carotid monitoring device, aims to detect pressure changes preceding clinical detection.

Case Report / Trial: A blinded, prospective, multicenter study was conducted in Israel (Sheba, Shaare Zedek, and Galilee Medical Centers) and Spain (Val de Hebron Hospital). The study enrolled ICU/stroke unit patients at high risk for stroke, including those with acute ischemic stroke, transient ischemic attack (TIA), post-cardiac surgery, and subarachnoid hemorrhage. Avertto™ was externally applied to the neck to monitor carotid pressure changes. Blinded algorithmic analysis assessed pressure changes, simulating alerts when predefined thresholds were met.

High impact reason: Avertto™ detected LVOs and pressure changes significantly earlier than clinical teams, with detection times ranging from 10 hours to five days before clinical confirmation. The device has the potential to transform stroke care by enabling real-time monitoring and early intervention, improving patient outcomes.

Results: The study included 17 participants. Avertto™ detected all confirmed LVOs with 100% sensitivity and 86% specificity. Key findings include:

• A 78-year-old undergoing cardiac surgery had an undetected stroke; Avertto™ identified it five days earlier.

• A 61-year-old with MCA stroke showed recanalization; Avertto™ detected improvement 10 hours earlier.

• Vasospasm-related changes were detected in subarachnoid hemorrhage patients, though distinguishing pathological stiffness remains a challenge.

• Sedated patients enabled continuous monitoring, while awake patients tolerated the device for over 12 hours.

A real-time alert study is planned to validate these findings, and assess alerting for clinical decision-making.

Disclosure of interest: Marufat Odetunde et al.: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2649 - ESOC2025-LB-515

SUB-ANALYSIS OF SUMMIT MAX SHOWS CORRELATION BETWEEN FPE AND OPERATOR ENROLMENT VOLUME WITH THE MONOPOINT SYSTEM

James Caldwell¹, Ryan Priest², Sohyun Boo³, Mohammad Almajali⁴, Alhamza R Al-Bayati⁵, Ricardo Hanel⁶, M Shazam Hussain⁷, Jane Khalife⁸, Mohamad Abdalkader⁹, Ronald Budzick¹⁰, Ramesh Grandhi¹¹, Keith Woodward¹², Jazba Soomro¹³, Priyank Khandelwal¹⁴, Guilherme Dabus¹⁵

¹Auckland City Hospital, Auckland, New Zealand, ²Oregon Health & Science University, Oregon, United States, ³Rockefeller Neuroscience Institute, Dept of Neuroradiology, West Virginia University, Morgantown, United States, ⁴Mercy Health St. Vincent Medical Center, Toledo, United States, ⁵University of Pittsburgh Medical Center, Pittsburgh, United States, ⁶Baptist Health Jacksonville, Jacksonville, United States, ⁷Cleveland Clinic, Cleveland, United States, ⁸Cooper University Healthcare, Camden, United States, ⁹Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, United States, ¹⁰Ohio Health, Riverside, Ohio, United States, ¹¹University of Utah, Salt Lake City, United States, ¹²Fort Sanders Medical Center, Knoxville, United States, ¹³Medical City Plano Hospital, Plano, United States, ¹⁴University Hospital Newark Neurological Surgery, Newark, United States, ¹⁵Baptist Hospital of Miami, Miami, United States

Background: Prior studies suggest that thrombectomy outcomes improve with operator experience. The Monopoint Reperfusion System (Route 92 Medical) includes a super-bore aspiration catheter and has design differences compared to existing aspiration systems. We hypothesized that reperfusion outcomes with the novel platform may correlate with operator case volume.

Case Report / Trial: SUMMIT MAX was a multi-centre randomized controlled trial which compared the effectiveness and safety of the Monopoint Reperfusion System (Route 92 Medical) to the largest FDA-cleared aspiration device the Vecta 74 Aspiration System (Stryker Neurovascular).

Methods: A sub-analysis of first pass effect (FPE) and other endpoints was performed on the SUMMIT MAX trial data to compare the three leading enrolment sites (N=57) to the remaining cohort (N=109). The endpoint of FPE was defined as single pass mTICI ⩾2b without the use of adjunctive therapy as adjudicated by imaging core lab.

High impact reason: Demonstration of the relationship between operator enrollement volume and reperfusion outcomes with the novel super-bore aspiration platform.

Results: At the three leading enrolling sites, FPE was observed in 84.0% (21/25) of the Route 92 arm compared to 53.3% (16/30) in the Vecta arm (p=0.02). In comparison, the Route 92 system FPE at the other enrolling sites was lower at 52.5% (31/59). The Vecta FPE rate of 44.2% (19/43) at the other enrolling sites was comparable to the Vecta FPE rate at the top three sites.

Conclusion: First pass effect using the super large bore catheter with the Route 92 Monopoint System was increased with greater trial volume enrollment by the operators.

Disclosure of interest: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 05.01 - PREVENTION

P2650 - ESOC2025-LB-518

PROGNOSTIC IMPACT OF GLYCEMIC VARIABILITY ON ACUTE ISCHEMIC STROKE. THE GLIAS-III STUDY

Elena de Celis Ruiz¹, Silvia Pastor Yvorra¹, Noemí González-Pérez de Villar¹, María Martínez-Balaguer¹, Maria del Mar Freijo², Mar Castellanos³, Noemi Diez⁴, María Santamaria Cadavid⁵, Laura Amaya-Pascasio⁶, Arturo Fraga-Bau⁷, Raquel Delgado-Mederos⁸, Ana Isabel Calleja Sanz⁹, Juan Carlos Portilla¹⁰, M Angeles Ortega-Casarrubios¹¹, Blanca Fuentes¹

¹La Paz University Hospital Research Institute (IdiPAZ)., Department of Neurology and Stroke Center, Madrid, Spain, ²Cruces University Hospital. Biobizkaia Health Research Institute., Bizkaia, Spain, ³A Coruña University Hospital., A Coruña, Spain, ⁴Donostia University Hospital., Donostia, Spain, ⁵Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain, ⁶Torrecárdenas University Hospital, Health Research Center (CEINSA), Almería, Spain, ⁷University Hospital Complex of Vigo., Vigo, Spain, ⁸Santa Creu i Sant Pau Hospital, IIB-Sant Pau, Hospital Universitario Son Espases, Palma, Spain., Barcelona, Spain, ⁹Valladolid University Hospital, Valladolid, Spain, ¹⁰University Hospital San Pedro de Alcántara., Cáceres, Spain, ¹¹University Hospital 12 de Octubre., Madrid, Spain

Background: Glycemic variability (GV) is predictive of poor prognosis in critically-ill patients. We hypothesized that GV assessed with subcutaneous continuous glucose monitors (CGM) could predict mortality and poor functional outcome in acute ischemic stroke (IS).

Case Report / Trial: We conducted a multicentre observational prospective study including consecutive patients with acute IS. CGM were implanted in the first 24h since symptom onset and recorded for 96 hours. Primary endpoint was the relation between GV (standard deviation (SD) of mean blood glucose) within the first 48h and mortality (in-hospital and at 90 days). Secondary endpoints included the relation of GV with poor functional outcome (ERm 3-6) and NIHSS score at 90 days. Other formulas for GV measurement (MAG, MAGE, CV) were analysed as secondary endpoints.

High impact reason: In the GLIAS-III study, high GV measured with CGM in the first 48-72 was associated with higher odds of in-hospital mortality in patients with acute IS.This could be a new therapeutic target.

Results: Between June 2020 and August 2022, 192 patients signed informed consent, 152 completed CGM monitoring and 130 the 90-day follow-up. Of the 152 included patients, 61 were female (40.1%), median age was 74 years (IQR 60-82), 36 (23.7%) had a previous diagnosis of diabetes, mean basal NIHSS was 6 (IQR 3-12). A multivariant analysis did not show relationship between GV (measured using different formulas) and 90-day mortality, NIHSS or poor functional outcome; however, GV measured using the SD formula (OR 1.05 [1.00-1.11] p 0.036) was associated with a higher risk of in-hospital mortality after multivariate adjustment.

Disclosure of interest: nothing to disclose.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.05 - NEUROINTERVENTION

P2651 - ESOC2025-LB-524

Carotid Webs: Experience of the Neurology Department, Hassan II university hospital, Fez

Sara Zejli¹, Naima Chtaou¹, Siham Bouchal¹, Zouhair Souirti¹, Aouatef El Midaoui¹, Faouzi Belahsen¹

¹hassan II university hospital, fez, Morocco

Background: The carotid web should be systematically investigated following an ischemic stroke (IS),especially in young patients.we assess the benefits of carotid artery stenting in the management of dysplastic carotid diaphragms in young patients with ischemic stroke.

Case Report / Trial: Carotid webs are a potential cause of ischemic stroke. Due to its high recurrence risk,a radical treatment approach is necessary for secondary prevention. Our findings support carotid stenting as a safe and effective treatment option,providing excellent outcomes.

High impact reason: We conducted a retrospective study over a four-year period,including patients diagnosed with ischemic stroke due to a carotid web at the Neurology Department of CHU Hassan II Fez,who underwent carotid angioplasty and stentin.

Results: Seven patients were diagnosed with a carotid web.The average age was 46 years, with a slight male predominance. All patients presented with symptoms of stroke. The average NIHSS score was 11, ranging from 3 to 16. All patients had infarcts in the middle cerebral artery territory. A total of nine carotid webs were identified:A right-sided: 57% of cases; A left-sided:14% of cases and bilateral: 29% of cases. Three patients received intravenous thrombolysis (IVT), while two underwent thrombectomy. All seven patients were treated with carotid stenting within a median period of 7 days (range: 1 to 20 days). Post-stenting, patients were placed on dual antiplatelet therapy for three months, followed by single antiplatelet therapy. No cases of recurrent stroke or transient ischemic attack (TIA) were observed after treatment.

Disclosure of interest: All authors: nothing to disclose.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 04.01 - DIAGNOSIS/INVESTIGATION OF STROKE ETIOLOGY

P2652 - ESOC2025-LB-529

Impact of Teleconsultation in Neurology: Experience of the Neurology Department of Hassan II University Hospital in Fez

Khadija Ouchen¹, Naima Chtaou¹, Siham Bouchal¹, Aouatif El Midaoui¹, Faouzi Belahsen¹

¹Hassan II University Hospital, FEZ, Morocco

Background: Telemedicine is the practice of medicine using interactive communication techniques for data transfer, including consultation, diagnosis, and treatment. Tele-stroke is one of the primary uses of telemedicine in neurology.

Case Report / Trial: This retrospective study conducted over a period of 1 year and 7 months, includes all patients who benefited from teleconsultation, whether they were hospitalized in another healthcare facility or at home. The aim of the study is todescribe the impact of telconsultation on patient management.

High impact reason: Tele-stroke is a very effective tool, allowing the monitoring of patients during the acute phase of ischemic stroke, and even selecting those who require urgent revascularization treatment and organizing their management.

Results: 62 teleconsultations were conducted for 40 patients, of which 7 patients were unreachable. The average age was 74.2 years. The reason for transfer was the lack of available hospital beds. 48% of the patients were hospitalized in regional hospitals, while the remaining patients were hospitalized at home. The goals of the teleconsultation were to : assess the clinical condition, check medication adherence, and screen for bed-related complications.

Hospitalized patients received vitals monitoring, a minimal etiological workup, and physical therapy. We were able to identify and manage the following complications: neurological deterioration and the need for brain imaging, pneumonia, renal failure (1 patient), and constipation.

This activity also allowed us to: initiate curative anticoagulation, prescribe antihypertensive treatment and statins, and manage hyperglycemia. 10 patients died, while the others were admitted to our Neurology Department to continue the etiological management of their ischemic stroke.

Disclosure of interest: All authors: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 02.01 - INTRACEREBRAL HAEMORRHAGE

P2653 - ESOC2025-LB-531

LOW GLASGOW COMA SCALE IS RELATED TO POOR PROGNOSIS AFTER DECOMPRESSIVE CRANIECTOMY FOR ACUTE ISCHEMIC STROKE

Sennur Delibas Kati¹, Firdevs Ucan Tokuc¹, Beril Karacan¹

¹Antalya Training and Research Hospital Neurology, Antalya, Türkiye

Background:

PURPOSE: We aimed to determine the relationship between endovascular treatments (EVT) and the need for decompressive craniectomy (DK) in ischemic strokes and the characteristics of patients who underwent DK and required follow-up in intensive care conditions.

INTRODUCTION: It has been shown that EVT provides significant survival success, especially in ischemic strokes in which large vessels are affected. However, despite the application of EVT, there are different data in the literature regarding the development of the need for DC. In patients undergoing EVT, the expected infarct volume is larger and may lead to the need for DC. Knowing and evaluating the factors that cause this may be beneficial in predicting the need for DC.

Case Report / Trial: RESULTS: The data of 89 patients who underwent DC after ischemic stroke and were followed up in the Neurology Intensive Care Unit were retrospectively examined. The need for DC was significantly higher in the EVT group. Mortality was found to be significantly higher in the group with low Glasgow Coma Scale (GCS).

High impact reason: Both in the univariate and multivariate analysis Gkasgow coma scale is found to be related with prognosis.

Results: Low GCS in the preoperative period is also directly related to mortality and indicates that the affected area is larger despite the application of EVT in these patients.

Disclosure of interest: Dr. Pensato has no conflicts of interest to disclose.; Dr. Tanaka has no conflicts of interest to disclose.; Dr. AlShamrani has no conflicts of interest to disclose.; Dr. Katsanos has no conflicts of interest to disclose.; Dr. Balali has no conflicts of interest to disclose.; Dr. Ray has no conflicts of interest to disclose.; Dr. Kasner has no conflicts of interest to disclose.; Dr. Molina has no conflicts of interest to disclose.; Dr. Tanne has no conflicts of interest to disclose.; Dr. Xu has no conflicts of interest to disclose.; Dr. Falkenberg is an employee of AstraZeneca.; Dr. Ladenvall is an employee of AstraZeneca.; Dr. Shoamanesh has received research grants/contracts from AstraZeneca, Bayer, the Canadian Institutes of Health Research, Daiichi Sankyo Company, the Heart and Stroke Foundation of Canada, the National Institutes of Health, Octapharma USA, Inc., and Servier Affaires Medicales; has served on advisory boards for AstraZeneca, Bayer, Daiichi Sankyo Company, and Takeda Pharmaceutical Company; and has served on a data and safety monitoring board for Bayer.; Dr. Sharma has received research grants/contracts from Bayer and Bristol-Myers Squibb and has served as a consultant for Bayer.; Dr. Demchuk has received honoraria for lectures from AstraZeneca Canada and Novo Nordisk AS; has participated on advisory boards for Hoffmann-La Roche Limited and NovaSignal; has served on data and safety monitoring committees for Lumosa and Philips; holds stock and a patent (Patent number: 10373718; 2023039659; 20230277151) for Circle NVI.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.04 - THROMBOLYSIS

P2654 - ESOC2025-LB-557

Safety and Efficacy of Tenecteplase Versus Alteplase for Intravenous Thrombolysis in Acute Ischemic Stroke Patients on Direct Oral Anticoagulants: A Retrospective Registry Analysis

Lena Mers¹, Anna Bogdanova¹, Alexander Sekita¹, Stefan Schwab¹, Stefan T. Gerner¹

¹Department of Neurology, University Hospital Erlangen, Erlangen, Germany

Background: Despite current guidelines recommending against intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) under direct oral anticoagulation (DOAC), newer data indicate no increased bleeding risk. However, these observations are mainly based on Alteplase (rt-PA), whereas data for Tenecteplase (TNK) are scarce.

Case Report / Trial: We retrospectively compared data from our stroke registry of AIS patients with DOAC receiving IVT either with rt-PA or TNK. Primary outcome was symptomatic intracranial hemorrhage (sICH) as per SITS-Most criteria. Secondary outcomes included any ICH or relevant bleedings, mortality, neurological and functional outcome at discharge. Subanalyses were performed for drug-specific DOAC levels.

High impact reason: We reported no increased rate of (s)ICH for TNK compared to rt-PA in DOAC-treated AIS-patients, indicating a similar safety profile. Further, even moderate to high drug-specific plasma levels were no surrogate for hemorrhagic complications.

Results: 37 patients were included, 20 receiving TNK und 17 rt-PA. Mean age was 82y for TNK and 80y for rt-PA. Median NIHSS score at admission was 10 for TNK versus 7 for rt-PA, median plasma level 56ng/ml versus 35ng/ml, respectively. We found no statistically significantly increased risk for neither sICH (TNK 5.0% vs. rt-PA 5.9%, p=1.0), nor for other safety outcomes for TNK-treated patients compared to those with rt-PA. Neurological improvement (TNK 45% vs. rt-PA 29.4%) and excellent functional outcome (TNK 60% vs. rt-PA 35.3%) were more likely for TNK, although not statistically significant. Drug-specific DOAC levels were not associated with risk of bleeding.

Disclosure of interest: Merlin Somville: I declare no conflict of interest, and my work is funded through the BIOWIN project 'FRITE@home' (31st call for project; project number: 8526) supported by the Wallonia Public Service. Zélie Rosselli : I declare no conflict of interest, and my work is funded through the BIOWIN project 'FRITE@home' (31st call for project; project number: 8526) supported by the Wallonia Public Service. Edouard Ducoffre: I declare no conflict of interest, and my work is funded through the BIOWIN project 'FRITE@home' (31st call for project; project number: 8526) supported by the Wallonia Public Service. Geoffroy Saussez: nothing to disclose. Carlyne Arnould: nothing to disclose. Yannick Bleyenheuft: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 03.03 - PROGNOSIS AND OUTCOME AFTER STROKE

P2655 - ESOC2025-LB-559

MALONDIALDEHYDE (MDA) AND 8-HYDROXY-2′-DEOXYGUANOSINE (8-OHDG) LEVELS IN ISCHEMIC STROKE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Retnaningsih Retnaningsih^1,1, Adhimas Aryanto^1,1, Reise Wirayudha^1,1, Virgi Maharani^1,1

¹RSUP Kariadi Semarang, Department of Neurology, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia, semarang, Indonesia

Background: Stroke is a leading cause of mortality and disability worldwide, with ischemic stroke accounting for approximately 87% of all cases. Oxidative stress plays a crucial role in stroke pathogenesis, contributing to neuronal damage. Malondialdehyde (MDA) and 8-hydroxy-2′-deoxyguanosine (8-OHdG) are biomarkers of lipid peroxidation and DNA oxidative damage, respectively. This meta-analysis aims to evaluate the association between MDA and 8-OHdG levels and ischemic stroke, providing insight into their potential role as biomarkers for stroke diagnosis, severity, and prognosis.

Case Report / Trial: A systematic review and meta-analysis was conducted using 7 eligible studies published between 2012 and 2023. Inclusion criteria included studies assessing the relationship between MDA/8-OHdG and ischemic stroke in human subjects, written in English. Review articles were excluded. Effect sizes were categorized, and statistical analysis was conducted using a random-effects model due to significant heterogeneity (p<0.001). Publication bias was assessed using funnel plots and Egger’s test.

High impact reason: Analysis showed a significant positive association between MDA/8-OHdG levels and ischemic stroke (z = 3.145; p = 0.002). The pooled effect size (rRE = 0.789) indicated a strong relationship. Most studies (57%) showed a large effect size (d ⩾ 0.8), confirming the relevance of these biomarkers in ischemic stroke. No publication bias was detected (p = 0.299).

Results: MDA and 8-OHdG are significantly associated with ischemic stroke, highlighting their potential as biomarkers. Future research with larger, more diverse populations and standardized methodologies is recommended to establish their clinical utility further.

Disclosure of interest: All Authors: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 07.01 - TECHNOLOGY INNOVATIONS: ROBOTS, VIRTUAL REALITY, ARTIFICIAL INTELLIGENCE AND MORE

P2656 - ESOC2025-LB-561

THE IMPACT OF SECRETOME ADMINISTRATION ON INFARCT SIZE AND INFLAMATORY MARKERS IN AN ACUTE ISCHEMIC STROKE RAT MODEL

Retnaningsih Retnaningsih^1,1, Endang Kustiowati^1,1, Dodik Tugasworo^1,1, Yovita Andhitara^1,1, Perwita Arumningtyas^1,1, Mayang Permata^1,1, Reise Wirayudha^1,1, Virgi Maharani¹

¹RSUP Kariadi Semarang, Department of Neurology, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia, semarang, Indonesia

Background: Stroke is a major cause of disability and death, with few acute-phase treatments. Post-stroke neurorestoration involves neurogenesis, angiogenesis, and immunomodulation. Mesenchymal stem cell-derived secretome, rich in VEGF and IL-10, enhances neuroprotection, regeneration, and anti-inflammatory effects. This study evaluates secretome-VEGF’s effects on brain histopathology, IL-10 levels, and clinical outcomes in ischemic stroke Wistar rats.

Case Report / Trial: This randomized controlled experimental study involved 27 male Wistar rats divided into 3 groups: normal control, ischemic stroke receiving normal saline, and ischemic stroke receiving secretome. Ischemic stroke was induced via common carotid artery (CCA) ligation, followed by intravenous secretome (300 µL) or saline 6 hours post-ligation. Clinical outcomes were assessed using the modified Neurological Severity Score (mNSS) before ligation and on days 1, 3, 7, and 21. IL-10 levels were measured on days 3 and 21, and brain histopathology was evaluated using Hematoxylin-Eosin staining.

High impact reason: 27 male Wistar rats divided into 3 groups: normal control, ischemic stroke receiving normal saline, and ischemic stroke receiving secretome. Ischemic stroke was induced via common carotid artery (CCA) ligation, followed by intravenous secretome (300 µL) or saline 6 hours post-ligation. IL-10 levels were measured on days 3 and 21, and brain histopathology was evaluated using Hematoxylin-Eosin staining.

Results: Secretome significantly improved mNSS scores on days 7 (p=0.018) and 21 (p<0.001) and increased IL-10 levels (p<0.001) compared to controls. The secretome group also had significantly higher neuronal survival in hisptpatological appereance (p=0.001) by day 21. Higher IL-10 levels correlated with better motor function (r=-0.680, p=0.004) and lower mNSS (r=-0.651, p=0.006).

Disclosure of interest: Du Yang, Ding xin : nothing to disclose.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.06 - IMAGING - Hyperacute

P2657 - ESOC2025-LB-562

THE EFFECT OF THERAPEUTIC HYPOTHERMIA ON CHANGES IN SERUM RNA-BINDING MOTIF PROTEIN 3 (RBM3) LEVELS AND STROKE SEVERITY IN PATIENTS WITH ISCHEMIC STROKE

Retnaningsih Retnaningsih¹, Dwi Pudjonarko¹, Dodik Tugasworo¹, Radian Wiralabda¹, Reise Wirayudha¹, Virgi Maharani¹

¹RSUP Kariadi Semarang, Department of Neurology, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia, semarang, Indonesia

Background: Brain injury occurs when pathological stimuli exceed the brain’s capacity to recover. RNA-binding motif protein 3 (RBM3) plays a critical role in hypothermia-induced neuroprotection. Therapeutic hypothermia, applied using a thermoregulator blanket, may influence RBM3 expression and stroke severity, which can be assessed using the NIHSS score. This study aimed to evaluate the effect of therapeutic hypothermia on RBM3 levels and stroke severity in ischemic stroke patients across control, 12-hour, and 24-hour intervention groups.

Case Report / Trial: a pre- and post-test control group design. Subjects were acute ischemic stroke patients admitted to the Stroke Unit at RSUP dr. Kariadi, meeting inclusion criteria: age ⩾18 years, NIHSS score >5, and informed consent provided. Patients with fever, seizures, previous stroke, or malignancy were excluded. Data were analyzed using independent t-test, Mann-Whitney U, paired t-test, Wilcoxon, One-Way ANOVA, Kruskal-Wallis, Chi-Square, and Fisher Exact tests, with significance set at p<0.05.

High impact reason: A total of 21 patients were included. RBM3 levels significantly increased in the 24-hour intervention group compared to the control (p=0.006) and 12-hour group (p=0.014). NIHSS scores differed significantly between groups at baseline (p=0.006), and improved significantly after 12-hour (p=0.038) and 24-hour hypothermia (p=0.009) compared to control.

Results: A total of 21 patients were included. RBM3 levels significantly increased in the 24-hour intervention group compared to the control (p=0.006) and 12-hour group (p=0.014). NIHSS scores differed significantly between groups at baseline (p=0.006), and improved significantly after 12-hour (p=0.038) and 24-hour hypothermia (p=0.009) compared to control.

Disclosure of interest: Yang Du,Xin Ding: nothing to disclose.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.06 - IMAGING - Hyperacute

P2658 - ESOC2025-LB-581

Differential clinical stroke outcome despite succesfull mechanical restoration of flow in the area supplied by the artery being thrombosed - own experience

Krystian Mross¹, Wojciech Poncyljusz¹, Przemysław Nowacki¹, Marta Masztalewicz¹

¹Pomeranian Medical University, Szczecin, Poland

Background: Intracranial mechanical thrombectomy is a key advancement in ischemic stroke treatment, yet outcomes vary. Some patients fail to improve despite successful reperfusion.

This study analyzed factors influencing 90-day functional recovery after successful intracranial mechanical thrombectomy, focusing on return to independence.

Case Report / Trial: We analyzed 298 of 555 ischemic stroke patients treated at our center until February 18, 2023. Eligible patients had middle cerebral artery (MCA) occlusion (isolated or tandem with the internal carotid artery [ICA]), achieved near-complete/complete reperfusion (modified Treatment in Cerebral Infarction [mTICI] score 3/2b), and had full 90-day follow-up data.

Patients were categorized as Group I (modified Rankin Scale [mRS] ⩽2, n=152) and Group II (mRS >2, n=142). Factors analyzed included demographics, stroke risk factors, intervention timing, treatment approach, stroke severity (National Institutes of Health Stroke Scale [NIHSS]), body temperature, blood glucose, inflammatory markers, and blood pressure.

High impact reason: Strengthen knowledge of factors that can improve clinical outcomes in stroke patients undergoing mechanical thrombectomy.

Results: Group I was younger (p=0.0017) with lower hypertension (p=0.0098) and diabetes rates (p=0.0304). Faster treatment (⩽6 hours) was linked to better outcomes. Mothership treatment improved recovery likelihood (p=0.0422). Lower NIHSS scores (p<0.001), admission temperature (p=0.0007), blood glucose (p=0.0016), and post-procedural blood pressure (p<0.001) correlated with better outcomes. Group II had significantly higher myocardial infarction rates (p=0.0379). The mortality in this group was 57.75%.

Disclosure of interest: John Holden: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 03.03 - PROGNOSIS AND OUTCOME AFTER STROKE

P2659 - ESOC2025-LB-65

GEKO VENOUS THROMBOEMBOLISM PREVENTION STUDY

Phillip Ferdinand¹, Wing To², David Wells¹, Anand Pandyan³, Alpesh Amin⁴, Martyn Lewis⁵, Brin Helliwell, Kieron Day², Christine Roffe^1,5

¹Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom, ²Firstkind Ltd, High Wycombe, United Kingdom, ³Bournemouth University, Bournemouth, United Kingdom, ⁴University of California, Irvine, Irvine, United States, ⁵Keele University, Keele, United Kingdom

Background: Venous thromboembolism (VTE) is a potentially fatal complication of stroke. Intermittent Pneumatic compression (IPC) is recommended for prevention. However, 30% of patients have contraindications to or cannot tolerate IPC. Surface neuromuscular electrostimulation of the peroneal nerve using the geko^™ device leads to rhythmic (1Hz) dorsiflexion of the foot improving venous flow. It is easier to use and better tolerated than IPC.

Case Report / Trial: This is a prospective, multicentre, randomized controlled trial to compare neuromuscular electrostimulation using the geko™ device with IPC for 30 days or until independently mobile. Adults admitted with acute stroke, unable to mobilize independently and within 36 hours of symptom onset will be included. Exclusion criteria include: DVT at screening, allergy to hydrogel, contraindications to IPC, palliative care. Asymptomatic DVTs will be assessed by leg Dopplers at day 7 (optional) and 14 (mandatory). Clinical suspicion of VTEs will also be recorded. The primary outcome is any VTE at 30 days. Secondary outcomes include device tolerance, neurological recovery, disability, quality of life, and home time at 90 days.

High impact reason: The aim of this study is to assess whether using the geko™ device is more effective than IPC at preventing VTE.

Results: First study site was opened June 2023 and to date 141/1200 patients have been recruited. Please contact [e-mail] for further details.

This study is funded by the NIHR i4i Challenge (NIHR203425). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Disclosure of interest: The authors report no conflicts of interest or external funding related to this work.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2660 - ESOC2025-LB-70

NON-INVASIVE VAGUS NERVE STIMULATION IN ACUTE ISCHAEMIC STROKE (NOVIS): A SINGLE-CENTER OPEN-LABEL, BLINDED-ENDPOINT RANDOMISED TRIAL

Anne van der Meij^{1 2}, Marianne van Walderveen³, Nyika Kruyt¹, Erik van Zwet⁴, Eric Liebler⁵, Adriaan van Es³, Kilian Treurniet³, Michel D Ferrari¹, Marieke Wermer^{1 6}

¹Department of Neurology, Leiden University Medical Center, Leiden, Netherlands, ²Department of Neurology, Amsterdam UMC, Amsterdam, Netherlands, ³Department of Radiology, Leiden University Medical Center, Leiden, Netherlands, ⁴Department of Biomedical Data Science, Leiden University Medical Center, Leiden, Netherlands, ⁵Nisola Consulting, Maine, United States, ⁶Department of Neurology, Groningen University Medical Center, Groningen, Netherlands

Background: Non-invasive Vagus Nerve stimulation (nVNS) has shown promise in preclinical studies in preventing secondary damage of the penumbra through inhibiting peri-infarct spreading depolarisations and inflammation in the first days after stroke. The aim of the NOVIS trial was to assess the radiological and clinical efficacy of nVNS in patients with an acute ischaemic stroke.

Case Report / Trial: NOVIS is an investigater driven single-center prospective randomised clinical trial with blinded outcome assessment. In total 150 patients presenting with acute ischaemic stroke within 12 hours from symptom onset and a perfusion deficit (penumbra comprising at least one-third of total ischaemic area) were randomised (1:1) to nVNS for five days with the gammaCore Sapphire^TM device in addition to standard treatment or standard treatment alone. The primary outcome was infarct volume on day five on MRI. Most important secondary outcomes were tolerability and clinical outcome measured with the NIHSS on day five and the modified Rankin Scale on day 90.

High impact reason: Preclinical data in acute stroke models suggest that (n)VNS reduces secondary damage in the penumbra and improves functional outcome after stroke. This effect is unproven in humans. The NOVIS trial addresses this gap in knowledge providing important data on the potential neuroprotective effects of nVNS in acute ischaemic stroke care.

Results: Patient enrollment commenced in October 2019 and concluded in November 2023. Data analysis is currently ongoing. The trial is registered on www.clinicaltrials.gov (NCT04050501).

Disclosure of interest: nothing to disclose

02.00 - INTRACRANIAL HEMORRHAGE - 03.04 - BRAIN REORGANISATION AND RECOVERY

P2661 - ESOC2025-LB-134

INTERNATIONAL CARE BUNDLE EVALUATION IN CEREBRAL HEMORRHAGE RESEARCH (I-CATCHER): A BATCHED PARALLEL CLUSTER-RANDOMIZED TRIAL WITH A BASELINE PERIOD

Menglu Ouyang, Teresa Ullberg¹, Trine Apostolaki-Hansson¹, Bo G. Norrving, Craig Anderson

¹Lund University, Lund, Sweden

Background: Though there is a demonstrated beneficial effect of care bundle for acute spontaneous intracerebral hemorrhage (ICH), uncertainty remains about the effectiveness of particular components of the care bundle and their applicability at a global scale. The aim is to determine the effectiveness and implementation of a Care Bundle that involve the rapid correction of abnormal physiological variables and referral pathways versus with usual care, on functional recovery defined by utility-weighted modified Rankin scale (UW-mRS) scores for patients with acute ICH.

Case Report / Trial: An international, multicenter, batched, parallel, cluster, randomized clinical trial with a focus on implementation and quality improvement. Adults with ICH admitted hospital within 24 hours of the onset of symptoms will receive either Care Bundle with time- and target-based metrics early physiological control (intensive blood pressure lowering, glycemic control, and treatment of pyrexia), reversal of anticoagulation, avoidance of do-not-resuscitate orders, and referral pathways for intensive care and neurosurgery, or usual care. In each batch, hospitals are randomized into two groups according to the timing of the intervention over three phases (baseline/usual care, randomized evaluation and post-implementation follow-up). Both clinical (i.e. UW-mRS, mortality and quality of life at 6 months) and implementation (i.e. fidelity, feasibility and sustainability) outcomes will be evaluated. A total of 3500 ICH patients from 110 hospitals will provide 90% power (α=0.05) to detect a plausibly larger effect size of 0.20.

High impact reason:I-CATCHER aims to provide solid evidence and bring changes to clinical practice by integrating the care bundle as part of well-organised multidisciplinary care in stroke settings.

Results:

Disclosure of interest: All the authors declare that they have no conflicts of interest.

02.00 - INTRACRANIAL HEMORRHAGE - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P2662 - ESOC2025-LB-138

NON-CONTRAST COMPUTED TOMOGRAPHY MARKERS OF HEMATOMA EXPANSION AND RESPONSE TO ANDEXANET IN FXA INHIBITOR-ASSOCIATED INTRACRANIAL HEMORRHAGE – SECONDARY ANALYSES OF ANNEXA-I

Koji Tanaka¹, Umberto Pensato^1,2, Mohamed Alshamrani¹, Ariesteidis Katsanos³, Pargol Balali⁴, Sucharita Ray¹, Scott Kasner⁴, Jan Beyer-Westendorf⁵, Danilo Toni⁶, Lizhen Xu³, Mikael Knutsson⁷, Per Ladenvall⁷, Mike Sharma³, Ashkan Shoamanesh³, Andrew Demchuk¹

¹Cumming School of Medicine, University of Calgary, Calgary, Canada, ²Department of Biomedical Sciences, Humanitas University, Milan, Italy, ³Population Health Research Institute, McMaster University, Hamilton, Canada, ⁴University of Pennsylvania, Philadelphia, United States, ⁵University Hospital Dresden, Dresden, Germany, ⁶Sapienza University of Rome, Rome, Italy, ⁷Biopharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden

Background: Non-contrast CT (NCCT) markers of hematoma expansion (HE) have been proposed to select patients with acute intracerebral hemorrhage (ICH) who benefit most from hemostatic treatments. Andexanet alfa is a modified recombinant FXa decoy that rapidly reverses the anticoagulant effect of FXa inhibitors (FXai). We sought to evaluate the prognostic utility of NCCT markers of HE in patients with acute FXai-associated ICH and whether presence of these markers modify the effects of andexanet.

Case Report / Trial: Post-hoc secondary analyses of ANNEXa-I trial (NCT03661528) participants with qualifying ICH. Baseline NCCT markers of HE (fluid level, blend, black hole, swirl, island, and satellite sign, and Barras shape/density scale) were categorized by two blinded adjudicators and disagreements resolved by consensus.

High impact reason: This post-hoc secondary analyses of the ANNEXa-I trial focused on baseline NCCT markers of HE will assist physicians in individualized clinical-decision making when treating patients with acute FXai-associated ICH.

Results: The primary efficacy outcome is an increase in hematoma volume of ⩾12.5mL or ⩾35% between imaging obtained at baseline and 12 hours following randomization. Sensitivity, specificity, overall diagnostic accuracy (ODA), positive likelihood and negative likelihood measures will be derived for each marker from cross tabulations. Multivariable logistic regression using the dichotomized HE as the outcome and NCCT predictors identified from the baseline univariable analysis (P value <0.10) will be performed. Treatment interactions examining the probability of HE stratified by treatment arm for each independent variable will be assessed. Additionally, treatment interactions for the safety outcome of thrombotic events at 30 days will be explored.

Disclosure of interest: NO CONFLICT OF INTEREST

02.00 - INTRACRANIAL HEMORRHAGE - 06.01 - PATHOPHYSIOLOGY OF STROKE / TRANSLATIONAL MEDICINE

P2663 - ESOC2025-LB-147

THE DUTCH INTRACEREBRAL HAEMORRHAGE SURGERY TRIAL; MINIMALLY INVASIVE ENDOSCOPY-GUIDED SURGERY IN SPONTANEOUS SUPRATENTORIAL INTRACEREBRAL HAEMORRHAGE

Axel Wolsink¹, Floor N.H. Wilting¹, Nadia H.C. Colmer², Bart Brouwers³, Jeroen Boogaarts⁴, Diederik Dippel⁵, Wilmar Jolink⁶, Floris Schreuder¹, William Peter Vandertop⁷, Marieke Wermer⁸, Ruben Dammers², Karin Klijn¹

¹Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands, ²Department of Neurosurgery, Erasmus Medical Centre Stroke Centre, Rotterdam, Netherlands, ³Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands, ⁴Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, Netherlands, ⁵Department of Neurology, Erasmus Medical Centre Stroke Centre, Rotterdam, Netherlands, ⁶Department of Neurology, Isala Hospital, Zwolle, Netherlands, ⁷Department of Neurosurgery, Amsterdam University Medical Centre, Amsterdam, Netherlands, ⁸Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands

Background: Intracerebral haemorrhage (ICH) accounts for 16-19% of all strokes in Western Europe and contributes profoundly to mortality and disability. Increasing evidence suggests that surgical treatment may be beneficial, in particular with minimally invasive procedures and when performed early. The aim of the Dutch ICH Surgery Trial (DIST) is to assess whether minimally invasive endoscopy-guided surgery within 8 hours of symptom onset improves functional outcome after spontaneous supratentorial ICH when compared to standard medical management.

Case Report / Trial: DIST is a multicentre, prospective, randomised, open clinical trial with blinded outcome assessment. We will include 600 adults (⩾18 years) with a spontaneous supratentorial ICH with a volume ⩾10mL and NIHSS ⩾2. Patients with an underlying aneurysm, arteriovenous malformation or fistula, cerebral venous sinus thrombosis, cavernoma or tumour will be excluded. Patients will be randomised (1:1) to minimally invasive endoscopy-guided surgery within 8 hours of symptom onset in addition to standard medical management or to standard medical management alone. The primary outcome is the modified Rankin Scale score at 180 days. The treatment effect estimate will be adjusted for known prognostic variables.

High impact reason: DIST will provide evidence on whether minimally invasive endoscopy-guided surgery improves functional outcome in ICH.

Results: DIST has started in November 2022 and will be conducted in 11 neurosurgical centres in the Netherlands. Currently, 180/600 participants (30%) have been randomized (February 2025). Baseline characteristics are shown in Table 1. Final results are expected in May 2028.

DIST is registered at ClinicalTrials.gov (NCT05460793).

Disclosure of interest: All the authors declare that they have no conflicts of interest.

02.00 - INTRACRANIAL HEMORRHAGE - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P2664 - ESOC2025-LB-263

IMAGING MARKERS OF ISCHEMIC CEREBROVASCULAR DISEASE AND RESPONSE TO ANDEXANET IN FXA INHIBITOR-ASSOCIATED INTRACRANIAL HEMORRHAGE – SECONDARY ANALYSES OF ANNEXA-I

Umberto Pensato^1,2, Koji Tanaka¹, Mohamed Alshamrani¹, Ariesteidis Katsanos³, Pargol Balali⁴, Sucharita Ray¹, Scott Kasner⁴, Carlos A. Molina, David Tanne⁵, Lizhen Xu³, Cecilia Falkenberg⁶, Per Ladenvall⁶, Ashkan Shoamanesh³, Mike Sharma³, Andrew Demchuk¹

¹Cumming School of Medicine, University of Calgary, Calgary, Canada, ²Department of Biomedical Sciences, Humanitas University, Milan, Italy, ³Population Health Research Institute, McMaster University, Hamilton, Canada, ⁴University of Pennsylvania, Philadelphia, PA, United States, ⁵Rambam Health Care Campus, Technion, Israel Institute of Technology, Haifa, Israel, ⁶Biopharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden

Background: Andexanet reduced hematoma expansion but increased thrombotic events (TE) in factor Xa inhibitor (FXa-i)-associated intracranial hemorrhage. Baseline imaging markers of ischemic cerebrovascular disease may help identify patients at greater risk of thrombotic complications.

Case Report / Trial: Post-hoc secondary analyses of ANNEXa-I trial participants. Markers of ischemic cerebrovascular disease (subcortical and cortical infarcts, white matter hyperintensities, arterial calcification, and evidence of cerebrovascular atherosclerosis) were independently identified on baseline imaging by two blinded, trained adjudicators, with disagreements resolved by consensus. Logistic regression analyses investigated associations between any TE (venous and arterial) or arterial (stroke, myocardial infarction, and systemic embolus) TE at 30 days and ischemic imaging markers, as well as treatment interactions.

High impact reason: No ischemic imaging markers predicted TE or modified the safety of Andexanet. Andexanet should not be withheld based on imaging markers of pre-existing ischemic cerebrovascular disease.

Results: Among 529 patients, 503 (95.1%) had non-contrast CT, 170 (32.1%) CT angiography, and 26 (4.9%) MRI. TE occurred in 42 (7.9%) patients, including 35 (6.6%) arterial TE cases. Overall, 200 (37.8%) patients had a Van Swieten Scale ⩾3, 203 (38.4%) ⩾1 old infarction, 203 (38.4%) an arterial calcification score ⩾3, 5 (3.6%) an aortic arch grading score ⩾3, 55 (10.4%) ⩾1 intracranial artery stenosis, and 90 (17.0%) an intracranial artery calcification. No association between ischemic markers and any TE or arterial TE was detected in univariable analyses; thus, no multivariable model was explored. There was no significant interaction between any markers and treatment outcomes.

Disclosure of interest: Sennur Delibas Kati: nothing to disclose, Ender Uysal: nothing to disclose, Merve Gursoy Hasoglan: nothing to disclose

02.00 - INTRACRANIAL HEMORRHAGE - 05.03 - EPIDEMIOLOGY & RISK FACTORS

P2665 - ESOC2025-LB-535

Quantitative evaluation of early antifibrinolytic therapy on 90-day mortality in elderly patients with acute traumatic subdural hematoma: insights from a prospective cohort study

Tao Liu^1,2, Zhihao Zhao³, Rongcai Jiang^1,3

¹Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China, ²The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia, ³Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China

Background:

Acute traumatic subdural hematomas (aTSDH) represent a frequent and critical neurosurgical emergency, associated with a significant risk of mortality. Elderly patients with symptomatic aTSDH may benefit from early antifibrinolytic therapy (EAFT).

Case Report / Trial: This study is part of a multi-center, prospective investigation of multimodal treatments for aTSDH (Trial Registration Number: ChiCTR2300075327).

High impact reason: This study investigated whether EAFT could improve clinical outcomes in aTSDH patients and explored the factors influencing mortality.

Results: A total of 297 aTSDH patients were identified, of whom 195 received EAFT, and 102 were in the control group. After propensity score matching (PSM), 80 patients in each group were compared. There were no significant differences in 90-day mortality (before PSM, P=0.439; after PSM, P=0.828). The difference between the two group in the incidence of brain rebleeding, sepsis, gastrointestinal bleeding, and renal failure were similar before and after PSM. The EAFT group had a significantly higher incidence of vascular occlusion compared to the control group (before PSM, P=0.014; after PSM, P=0.027). In multivariate logistic regression (odds ratio [95% confidence interval]), increased 90-day mortality was predicted by larger hematoma volume (2.329 [1.123–4.830], P=0.023) and greater midline shift (2.251 [1.065–4.755], P=0.034). Sensitivity analysis indicated that there was heterogeneity in the treatment effects between the two groups across different midline shift categories (before PSM, P=0.012; after PSM, P=0.043). The results of this study indicate that EAFT in elderly patients with aTSDH does not reduce mortality or decrease the rate of rebleeding, but significantly increases the incidence of ischemic events.

Disclosure of interest: nothing to disclose

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.01 - REHABILITATION

P2666 - ESOC2025-LB-132

Ongoing trial update for the AVERT DOSE trial: Determining Optimal Early Mobility Training after Stroke

Julie Bernhardt¹, Leonid Churilov, Geoffrey A. Donnan², Fiona Ellery¹, Coralie English³, Kathryn Hayward², Peter Langhorne⁴, Richard Lindley⁵, Sandy Middleton⁶, Andrews Jeyaraj Pandian⁷, Brooke Parsons¹, Vincent Thijs, Avert Dose Trialist Collaboration¹

¹The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia, ²University of Melbourne, Parkville, Australia, ³University of Newcastle, Newcastle, Australia, ⁴University of Glasgow, Glasgow, United Kingdom, ⁵University of Sydney, Sydney, Australia, ⁶Australian Catholic University, Sydney, Australia, ⁷Medical College and Hospital, Ludhiana, India

Background: AVERT DOSE uses a novel adaptive trial design to determine the optimal mobility training for mild and moderate ischemic stroke patients in the acute phase.

Case Report / Trial: This is an ongoing global Multi-Arm, Multi-Stage, Covariate-Adjusted, Response-Adaptive randomised trial. Patients in mild (NIHSS 0-7) and moderate (NIHSS 8-16) stroke severity strata are randomised to one of four mobility training regimens (including a pre-specified reference group), starting within 48 hrs of stroke and up to 14 days. Severe stroke (NIHSS>16), medically unwell, no evident mobility problem are exclusions. Primary Outcome is favourable outcome (mRS score 0-2) at 3 months. Sample re-estimation occurs at n=1400.

High impact reason: Robust early rehabilitation protocols can only be achieved with international clinical trials.

Results: Recruitment to Jan 2025 sits at 821 participants (Australia n=148, Singapore n=43, Malaysia n=80, India n=343, UK n=93, Ireland n=29, Brazil n=85). Drop outs are low (2.3 %). Participant demographics by county vary:

Country	%<65 yrs	%Male	%Mild (nihss<8)	%HT	%AF	%Smoking
Australia	22.4	59.5	75.5	70.3	22.3	52
India	61.8	56	60.2	61.3	5.7	18
Malaysia	61.3	54	61.3	74.4	21.8	35
Singapore	62.8	55.8	88.4	75	9.7	27
UK	31.2	58	61.0	59.8	22.8	53
Ireland	27.6	73.3	65.5	73.1	30.8	34.4
Brazil	54.8	49	57.1	61.3	6.4	47.6

Intervention delivery and quality trial conduct is feasible in both high and low-income countries. Results will be generalisable.

Disclosure of interest: Ibodulloyeva Maftuna: nothing to disclose. Fayziyeva Ra’nogul: nothing to disclose. Gafurova Sabohat: nothing to disclose.

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 05.04 - STROKE COMPLICATIONS

P2667 - ESOC2025-LB-163

IMPACT OF ORAL ANTICOAGULATION MECHANISMS ON RECANALIZATION OUTCOMES OF MECHANICAL THROMBECTOMY IN LARGE VESSEL OCCLUSION STROKE

Khadija Mammadli¹, Timo Uphaus²

¹Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, Mainz, Germany, ²Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany, Mainz, Germany

Background: Mechanical thrombectomy (MT) is the standard treatment for large vessel occlusion (LVO) in acute ischemic stroke. However, the influence of pre-existing oral anticoagulation (OAC) therapy on recanalization outcomes and safety remains insufficiently studied. This study compares direct thrombin inhibitors (DTIs) and factor Xa inhibitors (FXaIs) regarding their impact on recanalization success, functional outcomes, and complications.

Case Report / Trial: A retrospective analysis was conducted using data from the German Stroke Registry-Endovascular Treatment (GSR-ET) between 2015 and 2019. Patients receiving OAC with DTIs (n=146) or FXaIs (n=1760) prior to MT were included. Primary outcomes included successful recanalization (mTICI ⩾2b), first-pass effect (FPE), functional independence (modified Rankin Scale, mRS 0–2 at 90 days), and safety parameters such as symptomatic intracranial hemorrhage (sICH).

High impact reason: Understanding the influence of different OAC mechanisms on MT outcomes is critical to optimizing treatment strategies for LVO stroke patients. This study is among the first to compare DTIs and FXaIs in this context.

Results: Preliminary analysis demonstrated no significant differences in successful recanalization rates (mTICI ⩾2b: DTIs 84.9% vs. FXaIs 83.8%, p=0.62) or FPE rates (DTIs 29.8% vs. FXaIs 31.5%, p=0.45). Functional independence was achieved in 41.2% of patients on DTIs and 39.7% on FXaIs (p=0.72). The sICH rates were comparable (DTIs: 3.5% vs. FXaIs: 3.2%, p=0.68).

Disclosure of interest: Annuradhaa Ravi: Nothing to disclose

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.01 - REHABILITATION

P2668 - ESOC2025-LB-182

DOSE RANGING IN UPPER LIMB REHABILITATION LATE POST-STROKE (DOSE-UP): A NOVEL MULTIDIMENSIONAL PHASE I TRIAL PROTOCOL

Emily Osborn^1,2, Leonid Churilov, Bruce Campbell, Natasha Anne Lannin^3,4, Kathryn Hayward^1,2

¹Royal Melbourne Hospital, Melbourne, Australia, ²University of Melbourne, Melbourne, Australia, ³Monash University, Clayton, Australia, ⁴Alfred Health, Melbourne, Australia

Background: A systematic pipeline approach to stroke recovery intervention development is rare. The limited number of early-phase dose trials has resulted in a lack of consideration for the complexity of dose and its role within an intervention. The aim is to determine the tolerable dose range of an upper limb motor intervention conducted late (3-24 months) post-stroke. It is hypothesised that the maximum tolerated dose regimen will be higher than the dose of usual care currently provided.

Case Report / Trial: Multidimensional Phase I dose-ranging trial using a 3+3 rule-based design. The trial delivers usual care upper limb motor therapy per the Australian Stroke Clinical Practice guidelines. The trial will escalate two dimensions of dose: 1) number of sessions per day (range 2 to 4 sessions per day) and 2) total time in therapy across the day (range 3 to 6 hours per day). All dose dimensions (e.g., time on task) will be recorded. The starting dose is 6 hours of therapy delivered over 4 x 90-minute sessions per day. People 3 to 24 months post-stroke with a Rating of Everyday Arm-use in Community and Home (REACH) score of 1 to 3 are eligible. Trial Registration: ACTRN12620000215921.

High impact reason: This novel trial design will determine the dose range of an upper limb motor intervention late post-stroke. This outcome will inform the selection of doses to test in a Phase IIA trial to determine signal of efficacy.

Results: Trial recruitment will commence in early 2025.

Disclosure of interest: Dr. Narendra Nath Jena: nothing to disclose Prof. Parvati Nandy: nothing to disclose Dr. Ramesh Ardhanari: nothing to disclose Dr. Rakesh Kumar Saroj: nothing to disclose

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.01 - REHABILITATION

P2669 - ESOC2025-LB-211

MOBILE MEDICAL APPLICATION BASED POST-STROKE CARE STRATEGY (MOBILITY) FOR SURVIVORS AND THEIR CAREGIVERS: A RANDOMIZED CONTROLLED TRIAL (ONGOING)

Dhiraj Khurana¹, Ashok Kumar¹, Pawna Kaushal¹, Smita Pattnaik¹, Sucharita Ray¹, Shankar Prinja¹, Andrews Jeyaraj Pandian², Pn Sylaja³, Rohit Bhatia⁴, Shweta Verma², Deepti Arora², Meenakshi Sharma⁵, Aneesh Dhasan³, Pheba Susan³, Arya Devi², Biman Kanti Ray⁶, Sanjith Aaron⁷, Vivek Nambiar⁸, Rupjyoti Das⁹, Girish B Kulkarni¹⁰, Sanjeev Bhoi¹¹, Vijaya Pamidimukkala¹², Neetu Ramrakhiani¹³, Sapna E. Sreedharan³, U Aruna Kumari¹⁴, Sankar G¹⁵, Gaurav Mittal¹⁶, Kumaravelu Somasundaram¹⁷, Sulena Sulena¹⁸, Roy Jayanta¹⁹

¹Postgraduate Institute of Medical Education and Research, Chandigarh, India, ²Christian Medical College & Hospital, Ludhiana, India, ³Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, India, ⁴All India Institute of Medical Sciences, Delhi, India, ⁵Indian Council of Medical Research, New Delhi, India, ⁶Bangur Institute of Neurosciences, Kolkata, India, ⁷Christian Medical College, Vellore, India, ⁸Amrita Institute of Medical Sciences and Research Centre, Kochi, India, ⁹GNRC Hospitals, Guwahati, India, ¹⁰National Institute of Mental Health and Neurosciences, Bangalore, India, ¹¹All India Institute of Medical Sciences, Bhuvneshwar, India, ¹²Lalitha Super Specialties Hospital Pvt Ltd, Guntur, India, ¹³Fortis Escorts Hospital, Jaipur, India, ¹⁴Government General Hospital, Guntur, India, ¹⁵Bharati Vidyapeeth DTU Medical College, Pune, India, ¹⁶St Stephens Hospital, Delhi, India, ¹⁷Dr Ramesh Cardiacand Multispecialty Hospital, Guntur, India, ¹⁸Guru Gobind Singh Medical college and hospital, Faridkot, India, ¹⁹Institute of Neurosciences, Kolkata, India

Background: Strokes in LMICs have limited access to Rehabilitation.Rapid growth of smartphones provides opportunities for mobile app interventions. A pilot mobile application based study demonstrated reduction in post-stroke complications at three months. MOBILITY is a multicentre trial to evaluate efficacy of mobile application in reducing post-stroke complications.

Methods: Recruitment initiated in April ‘24 across19 sites in India,targeting 2,636 participants. Major Inclusions are age ⩾18 years, first-ever /recurrent stroke,premorbid mRS ⩽2 (ischemic/haemorrhagic/Cerebral venous thrombosis),recent duration(<3 months),mRS ⩾3,caregivers providing care,smartphone access.Exclusions are traumatic intracerebral /subarachnoid/subdural haemorrhage and stroke survivors without caregivers or hired/illiterate caregivers. Eligible patients are randomly assigned to either intervention arm(MOBILITY App and booklet) or control(booklet). The App is available in 11 Indian languages, offers post-stroke home care videos for caregivers.

Case Report / Trial:

High impact reason:

Results: 606 eligible patients currently recruited till December 2024, mean age 56 ± 14 years, 65% males, 63% ischemic, 33% hemorrhagic strokes, and 4% CVT. Median mRS is 4 (3-5) and NIHSS score 10 (7-14). Major risk factors: hypertension (57%), diabetes (30%), alcoholism (21.6%), smoking (14.7%), family history of stroke (7%), CAD (6.6%), and dyslipidemia (6%).Baseline post-stroke complications observed are speech abnormalities (52%), in dwelling catheter (33%), feeding tube (30%), dysphagia (28%), bedsores (4.3%), aspiration pneumonia (2.8%), tracheostomy (2.3%), and nasal regurgitation (2.1%). 319 and 142 have completed 3-month and 6-month follow-up respectively.Conclusions: MOBILITY will provide evidence on use of Mobile application to prevent post stroke complications.

Disclosure of interest: NA

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 07.01 - TECHNOLOGY INNOVATIONS: ROBOTS, VIRTUAL REALITY, ARTIFICIAL INTELLIGENCE AND MORE

P2670 - ESOC2025-LB-23

FEASIBILITY OF CONTEXT-SPECIFIC COMMUNITY-REINTEGRATION GUIDELINES FOR STROKE SURVIVORS IN NIGERIA

Marufat Odetunde^1,1, Olamide Olaoye², Oluwafunbi Ogungbe³, Temilope Opadara³, Olayinka Kolawole³, Oluwafemi Ilesanmi⁴, Michael Ogudamen⁵, Olalekan Akanji⁶, Chidozie Mbada⁷, Francis Fatoye⁸

¹Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Birley Fields Campus, Bonsall Street, Manchester M15 6GX, Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Osun 220282, Nigeria, Manchester, United Kingdom, ²Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Osun 220282, Ile Ife, Nigeria, ³Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria, ⁴Department of Medical Rehabilitation, Obafemi Awolowo University Teaching Hospitals Complex, Ilesha Road, Ile Ife, Osun, Nigeria, ⁵Department of Medical Rehabilitation, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile Ife, Osun, Nigeria, ⁶Department of Medical Rehabilitation, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile Ife, Nigeria, ⁷Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Birley Fields Campus, Bonsall Street, M15 6GX, Manchester, United Kingdom, ⁸Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Birley Fields Campus, Bonsall Street, Manchester M15 6GX, Manchester, United Kingdom

Background: Community reintegration (CR) protocols tailored to low- and middle-income countries (LMIC) are limited. This study assessed the feasibility of a newly developed CR guidelines for stroke survivors (SSV) in Nigeria.

Case Report / Trial: This mixed-methods study involved consented community-dwelling SSV attending a tertiary health institution in a LMIC. The CR guidelines included: Assessment, Goal setting, Intervention, Dosage and Duration, Re-evaluation, Follow-up, and Implementation strategy. Participants had 12 bi-weekly physiotherapy and occupational therapy sessions for six weeks. Functional independence, balance, fear of falling (FoF), quality of life (QoL), motor function, and CR were measured at baseline, 3rd and 6th weeks using Barthel Index, Berg Balance Scale, Falls Efficacy Scale-International, Stroke-Specific QoL Scale, Fugl-Meyer Assessment for Upper and Lower Extremities and Reintegration to Normal Living Index, respectively. Seven SSV and caregivers had in-depth-interviews post-intervention. Quantitative data was analysed using descriptive and inferential statistics (p<0.05). Qualitative data was analysed thematically.

High impact reason: Context-specific CR guideline is feasible and should be adopted, emphasising culturally and resource-appropriate intervention to improve community participation and health outcomes of SSV.

Results: Eleven SSV(mean age=59.00±12.954 years; mean time since stroke=31.09±27.22 months) participated. Significant improvements were observed in balance (p=0.044) and FoF (p=0.049), with non-significant but notable improvements in other clinical and psychosocial outcomes (p>0.05) Qualitative analysis identified five themes: caregiver support, intervention benefits, participants’ confidence, multidisciplinary collaboration, enabling environments.

Disclosure of interest: The research team has no conflict of interest

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P2671 - ESOC2025-LB-251

EVALUATING THE IMPACT OF INTEGRATIVE AYURVEDIC THERAPY COMBINED WITH STANDARD MEDICAL CARE IN POST-STROKE REHABILITATION

Pushpendra Renjen¹, Dinesh Chaudhari¹, Avinash Goswami¹, Alisha Dhaniya²

¹Indraprastha Apollo Hospital, New Delhi, New Delhi, India, ²All India Institute of Ayurveda, New Delhi, India

Background: Stroke imposes immense economic and productivity burdens globally. Ayurveda offers a promising alternative, but its role in stroke management remains underexplored. This study evaluates the efficacy of Ayurvedic therapies in post-stroke recovery, focusing on clinical, biochemical, and quality-of-life outcomes. Panchakarma, a traditional Ayurvedic therapy, is commonly used for managing Pakshaghata (paralysis), and early reports suggest its potential to complement standard biomedicine. The study aims to compare the outcomes of Holistic Ayurvedic treatment combined with conventional care versus conventional care alone, measured by the Modified Rankin Scale (MRS), Modified Ashworth Scale (MAS), NIH Stroke Scale (NIHSS), Quality of Life (QoL), and disease-related anxiety.

Case Report / Trial: This ongoing Phase II clinical trial adopts a prospective, comparative, non-randomized design with an active-controlled intervention model. Ninety participants are divided into two groups: Group 1 receives standard medical care followed by Ayurvedic therapy, and Group 2 receives standard medical care alone. Assessments are conducted over 90 days, with primary outcomes focusing on clinical symptom reduction and secondary outcomes evaluating QoL and biochemical changes.

High impact reason: It is first ever standardised trial for integrative medicine. As demand for integrative approaches grows, this study addresses the pressing need for scientifically validated Ayurvedic interventions. Its findings aim to enhance post-stroke recovery strategies and expand treatment options.

Results: The trial is ongoing, with final data anticipated to provide critical insights into the benefits of combined Ayurvedic and conventional therapies. This study highlights Ayurveda's potential as a complementary approach in stroke rehabilitation.

Disclosure of interest: Johannes Kaesmacher: Nothing to disclose

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 05.02 - SECONDARY PREVENTION

P2672 - ESOC2025-LB-276

HABIT-ILE@HOME FOR CHRONIC STROKE: PRELIMINARY RESULTS OF A RANDOMISED CONTROLLED TRIAL

Merlin Somville¹, Zélie Rosselli¹, Edouard Ducoffre^1,2, Carlyne Arnould², Geoffroy Saussez², Yannick Bleyenheuft¹

¹UCLouvain, Institute of NeuroScience, Brussels, Belgium, ²Health and medical technologies department, CeREF-Santé - Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium

Background: Stroke is the leading cause of motor disability in adults, affecting quality of life. Interventions based on motor skills learning such as HABIT-ILE (Hand and Arm Bimanual Intensive Therapy Including Lower Extremities) effectively improves motor functions. Mainly delivered through on-site programs as a 2-weeks camp with 50 to 90 hours of therapy, access to these interventions is limited (e.g. remote areas. . .). This study tests the efficacy of a HABIT-ILE@home intervention with the hypothesis of non-inferiority compared to an on-site program.

Case Report / Trial: This study includes 41 participants with chronic stroke (31-82 years, mRS : 1-5) randomly assigned to HABIT-ILE@home (rehabilitation remotely supervised by trained therapists and administered by caregiver) or HABIT-ILE on-site camp (both 65h over 2-weeks). Fugl-Meyer-Assessment (FMA), blindly scored, is the primary outcome. Secondary outcomes include measures of manual dexterity, locomotion, daily activities and functional goals. Assessments were conducted before (T0) and after (T1) therapy. Statistical analysis investigates efficacy in both groups and test for non-inferiority of changes in HABIT-ILE@home compared to HABIT-ILE on-site (t-test or Mann-Whitney).

High impact reason: Despite significant improvements in both groups (T1-T0), HABIT-ILE@home may not reach non-inferiority for all outcomes. Despite the discrepancies for efficiency, a remote protocol can still be of interest when an on-site delivery is not achievable.

Results: Both groups showed significant improvements in functional goals (COPM) and locomotion (6WMT) (p<0.01). ABILHAND increased for HABIT-ILE on-site (p<0.05), while BBT and TUG improved for HABIT-ILE@home. Non-inferiority of HABIT-ILE@home was not established. FMA, mini-BESTest, and WMFT are currently being scored blindly.

Disclosure of interest: Wanwan Zhang, Chuanjie Wu, and Xunming Ji:nothing to disclose.

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2673 - ESOC2025-LB-284

VALIDATION OF EARLY PROGNOSTIC DATA FOR RECOVERY OUTCOME AFTER STROKE FOR FUTURE, HIGHER YIELD TRIALS (VERIFY) STUDY

Pooja Khatri¹, Steven Cramer², Cathy Stinear³, Achala Vagal¹, Harry Jordan³, Kalli Beasley¹, Sharon Yeatts⁴, Lydia Foster⁴, Tyler Behymer¹, Catherine Dillon⁴, Maxwell Mays¹, Natalia Hayes⁴, Laura Benken¹, Joseph Broderick¹, Scott Janis⁵, Carlos Faraco⁵

¹University of Cincinnati, Cincinnati, United States, ²University of California, Los Angeles, United States, ³University of Auckland, Auckland, New Zealand, ⁴Medical University of South Carolina, Charleston, United States, ⁵NINDS, Bethesda, United States

Background: The VERIFY study will validate biomarkers of 90-day upper extremity (UE) motor outcomes in the acute ischemic stroke window that have immediate potential for use in clinical trials. The objectives are to: (1) externally validate the association between transcranial magnetic stimulation (TMS) and MRI biomarkers of corticomotor system integrity, acquired acutely, with 90-day UE motor impairment, and (2) externally validate the PREP2 prediction tool for 90-day UE functional outcome. VERIFY will establish the first large-scale, multicenter, prospective dataset of clinical, TMS, and MRI measures within the acute stroke timeframe.

Case Report / Trial: This NIH StrokeNet study is recruiting adults with acute UE motor deficits within 24-96 hours post-stroke onset, at up to 45 hospitals across the U.S. Biomarkers are obtained within 48-168 hours of onset for MRI and 72-168 hours for TMS. Enrollments without usable data for both TMS motor evoked potential status and MRI lesion load are replaced. Primary outcomes are the day-90 UE-Fugl Meyer and Action Research Arm Test scores. Exploratory outcomes include the Motor Activity Log and modified Rankin Score at 90 days.

High impact reason: Immediately allow reliable prediction of patient outcomes after ischemic stroke to improve stratification and inform entry criteria in clinical trials, and enable personalised rehabilitation.

Results: To date, 30 sites are activated, with 12 additional sites pending activation. Enrollment began in July 2022, and recruitment is projected to conclude in 2026. Sample Size: 657 participants.

• Current Enrollments: 301 total

• Enrolled and in primary analysis: 292

• Ischemic stroke participants: 258

• Intracerebral hemorrhage participants: 34

Disclosure of interest: Anil Gulati is the inventor of this technology, has issued pending patents, and is an employee and stockholder of Pharmazz Inc. No conflicts are reported by any other author

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P2674 - ESOC2025-LB-321

THE STUDYING OF COGNITIVE DECLINE IN ISCHEMIC STROKE PATIENTS: A FOCUS ON CHORNOBYL LIQUIDATORS

Anna Militovska¹, Nataliya Nekrasova²

¹Ivankiv central district hospital, Ivankiv, Ukraine, ²Kharkiv National medical university, Kharkiv, Ukraine

Background: Ischemic stroke affects over 12 million people annually, with up to 70% of survivors developing post-stroke cognitive impairments (PSCI). In Ukraine, the health impact of radiation exposure from the Chornobyl disaster complicates this issue, increasing the risk of cerebrovascular conditions in liquidators.

Case Report / Trial: This study analyzed 30 ischemic stroke patients from Ivankiv Central District Hospital, Kyiv region. Patients were grouped by lesion volume (⩽10 cm³, 10–100 cm³, >100 cm³), cognitive impairment severity (none, mild, moderate, severe), and Chornobyl liquidator status. Assessments used the Montreal Cognitive Assessment (MoCA), PASAT, and SDMT. Spearman correlation and Kruskal-Wallis and Mann-Whitney tests were applied to analyze recovery over 3, 6, and 9 months.

High impact reason: The study addresses the interplay of stroke-related cognitive impairments and radiation exposure, providing insights for tailored rehabilitation strategies for radiation-exposed populations.

Results: The cohort included 18 men and 12 women, median age 65 years (IQR 59–68); 53.3% were Chornobyl liquidators. Median lesion volume was 45 cm³ (IQR 9–85). PSCI affected 73.3% of patients: mild (36.7%), moderate (26.7%), severe (10.0%). Cognitive deficits were more frequent in liquidators (80.1%) than non-liquidators (66.7%, p < 0.05). A moderate negative correlation was observed between lesion volume and MoCA scores (ρ = -0.45, p < 0.01). Liquidators exhibited slower cognitive recovery at 9 months (p < 0.05).

Disclosure of interest: nothing to disclose

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 05.02 - SECONDARY PREVENTION

P2675 - ESOC2025-LB-324

INHIBITION OF IPSILESIONAL M1 BETA OSCILLATIONS BY CONTRALESIONAL M1 FOLLOWING ACUTE ISCHEMIC STROKE: A TMS-EEG STUDY

Weili Jia¹, Yijun Zhou², Tao Liu, Zixiao Li¹

¹Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, ²Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China

Background: The mechanisms of motor recovery in the early stroke period remain unclear, limiting the use of neuromodulation techniques in the early stages of ischemic stroke.

Case Report / Trial:Nineteen patients with ischemic stroke onset within the past two weeks and sixteen matched healthy controls were included. TMS-evoked EEG potentials (TEPs), and power spectral density (PSD) of the ipsilesional M1 (ilM1) during bilateral M1 stimulation were calculated. Correlations between TMS-EEG parameters and initial functional impairment, assessed with the Fugl-Meyer Assessment (FMA) and upper extremity of FMA (FMA-UE), National Institutes of Health Stroke Scale (NIHSS), as well as changes in the NIHSS score between baseline and 3 months, were evaluated via Spearman’s correlation analysis (correlation coefficient as r).

High impact reason:TMS combined with high-density EEG was employed to investigate potential mechanisms underlying functional impairment and recovery following acute ischemic stroke. These findings can be used to optimize neurorehabilitation treatments and develop innovative therapeutic approaches at a personalized level.

Results:TEPs exhibited positive and negative deflections in healthy subjects, whereas the waveforms were simpler with lower amplitudes in stroke patients. Compared with healthy controls, stroke patients had a significantly lower resting motor threshold (clRMT)in the contralesional M1 [t=-2.79, P=0.009].The clRMT was positively associated with the LMFP25-35 ms of ilM1 (r=0.482, P=0.018). The power of beta oscillations was associated with FMA (r=-0.557, P=0.014), FMA-UE (r=-0.503, P=0.014), and changes in NIHSS (r=0.507, P=0.027). Negative associations were observed between the PSD of beta oscillations and FMA (r=-0.417, P=0.038) and FMA-UE(r=-0.389, P=0.05) with stimulation on clM1.

Disclosure of interest: Xiao Dong. nothing to disclose. Chuanjie Wu. nothing to disclose. Chengbei Hou. nothing to disclose. Yuanyuan Liu. nothing to disclose. Xunming Ji. nothing to disclose.

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.01 - REHABILITATION

P2676 - ESOC2025-LB-381

EFFECTIVENESS OF PSYCHOMOTOR REHABILITAION IN POST-ISCHEMIK STROKE RECOVERY: A CONTROLLED TRAIL

Maftuna Ibodulloyeva¹, Ra'nogul Fayziyeva¹, Sabohat Gafurova¹

¹Tashkent Medical Academy, Tashkent, Uzbekistan

Background: Stroke is a leading cause of death and disability worldwide. Traditional rehabilitation primarily focuses on motor recovery, often neglecting cognitive and psycho-emotional aspects. Psychomotor therapy, which integrates physical, cognitive, and emotional engagement, has emerged as an innovative approach to enhancing post-stroke recovery. This study evaluates its effectiveness compared to standard rehabilitation.

Case Report / Trial: A 12-week controlled trial was conducted at Tashkent Medical Academy and Hilol Med Center, enrolling 100 patients (aged 45–75) with first-time ischemic stroke. Participants were randomly assigned to two groups:

• Intervention Group (n=50): Psychomotor therapy + standard therapy

• Control Group (n=50): Standard therapy only

Functional recovery was assessed using the Barthel Index, Mini-Mental State Examination (MMSE), and Wellbeing, Activity, and Mood (WAM) scale at baseline and after 12 weeks.

High impact reason: This is one of the first controlled trials in Uzbekistan evaluating psychomotor therapy’s impact on post-stroke rehabilitation. With stroke’s economic burden projected to reach $1 trillion by 2030, innovative rehabilitation strategies are crucial for improving outcomes and reducing long-term disability.

Results: Compared to the control group, the intervention group showed greater improvements in:

• Barthel Index: +35.4 vs. +19.1 points (p < 0.001)

• MMSE: +5.1 vs. +2.3 points (p < 0.001)

• WAM Scale: +29.8 vs. +14.2 points (p < 0.001)

These findings highlight psychomotor therapy as a highly effective, holistic approach to stroke rehabilitation.

Disclosure of interest: Chen Xu is supported by the Research Postgraduate Scholarship from The Hong Kong Polytechnic University. Yifeng Wang and Meizhen Huang are supported by the Health and Medical Research Fund – Research Fellowship Scheme (No. 08220047) from the Health Bureau of the Government of the Hong Kong Special Administrative Region.

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 05.04 - STROKE COMPLICATIONS

P2677 - ESOC2025-LB-388

ENHANCING STROKE RECOVERY THROUGH TELE FOLLOW-UP: AN INNOVATIVE SOLUTION FOR RESOURCE-LIMITED SETTINGS

Narendra Jena¹, Parvati Nandy², Ramesh Ardhanari³, Rakesh Saroj⁴

¹Director & Clinical Head, Institute of Emergency Medicine, Meenakshi Mission Hospital & Research Centre, Madurai., India, ²Professor, Department of Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim, Gangtok, India, ³Medical Director & Head of the Institution, Meenakshi Mission Hospital & Research Centre, Madurai., India, ⁴Assistant Professor, School of Computational & Integrative Science Jawaharlal Nehru University New Mehrauli Road, New Delhi., New Delhi., India

Background:Stroke is a leading cause of disability worldwide, with significant challenges in resource-limited settings like India. Access to timely care, rehabilitation, and physiotherapy remains a major barrier, particularly in rural areas. Telemedicine, including platforms like WhatsApp, provides a potential solution by offering remote follow-up and rehabilitation guidance.

Case Report / Trial: This observational study was conducted with 250 stroke patients at Meenakshi Mission Hospital, Madurai, South Tamil Nadu. Tele-follow-up was carried out via WhatsApp video calls, where caregivers were trained remotely to provide home physiotherapy. The goal was to assess the feasibility and impact of telemedicine on stroke recovery, including functional outcomes and quality of life.

High impact reason: In resource-limited settings, telemedicine offers a cost-effective, accessible, and sustainable solution to improve stroke recovery. This study demonstrates the potential of digital platforms to address healthcare access issues and provide better rehabilitation, especially for patients in rural areas with limited healthcare resources.

Results: At 90 days post-discharge, 75.2% of patients showed substantial functional recovery, with significant improvements in speech and motor function. The tele-follow-up model was well-received, with 85% of caregivers reporting increased confidence in managing home-based rehabilitation. The study found that 74.4% of patients experienced cost savings from reduced travel and hospital visits. Overall, the telemedicine model proved to be effective, feasible, and sustainable for stroke rehabilitation in a resource-limited setting.

Disclosure of interest: all authors: nothing to disclose.

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 01.05 - NEUROINTERVENTION

P2678 - ESOC2025-LB-40

INTEGRATING AI IN STROKE NEUROREHABILITATION: A MULTICENTER RANDOMIZED CONTROLLED TRIAL OF THE AISN SOLUTION FOR AT-HOME REHABILITATION

Anna Mura¹, Adrian Guggisberg², Laura Danesin³, Francesca Burgio³, Giorgia Baron³, Raffaele Fiorillo⁴, Marina Serena⁴, Judit Lopez Luque⁴, Iñigo Chivite⁴, Stephane Mandigout⁵, Poeiti Abi Saab⁵, Jean-Christophe Daviet⁵, Stefan Strilciuc⁶, Adina Stan⁶, Diana Chira⁶, Lya Leal Mijares⁷, Santiago Brandi⁸, Theodore Nikoletopoulos⁹, Fabrizio Antenucci⁹, Ton Coolen⁹, Paul Verschure¹

¹University Miguel Hernandez, Elche, Alicante, Spain, ²University Hospital Geneva, UHG, Geneva, Switzerland, ³San Camillo, IRCCS, Venice, Italy, ⁴Parc Sanitari Sant Joan de Déu, PSSJD, Sant Boi, Spain, ⁵University of Limoges, UNILIM, Limoges, France, ⁶University of Medicine and Pharmacy Cluj-Napoca, UMF, Cluj-Napoca, Romania, ⁷Radboud University, Nijmegen, Netherlands, ⁸Eodyne Systems, Barcelona, Spain, ⁹Saddle Point Science, Nijmegen, Netherlands

Background: Stroke recovery demands personalized interventions that adapt to patient needs. The AISN project (Integrating AI in Stroke Neurorehabilitation) introduces an AI-driven solution integrating real-time data analysis, predictive modeling, and tailored exercise protocols to enhance at-home rehabilitation. The aim is to assess the clinical impact of AISN's AI-powered diagnostics, prognostics, and dynamic decision-support system, focusing on motor and cognitive recovery, patient engagement, and clinical efficacy.

Case Report / Trial: AISN is a multicenter study with 150 chronic stroke patients across five European countries, randomized into three groups: (1) AI-enhanced intervention with personalized recommendations), (2) digital intervention without AI, and (3) control (standard care). Experimental groups train using the Rehabilitation Gaming System (RGS+AI and RGS-AI) for 30 minutes daily over 12 weeks. Outcomes: motor function, cognition, quality of life, and usability are assessed at baseline, weeks 4, 8, 12, and 20.

High impact reason: This study leverages an AI decision-support module to provide clinicians with data-driven exercise recommendations and actionable insights via a user-friendly dashboard. This system optimizes therapy intensity, progression, and adherence while reducing clinician workload.

Results: We expect the AI-enhanced intervention group to achieve superior usability outcomes compared to digital intervention without AI and standard care. Preliminary results will emphasize the feasibility and transformative potential of AI in neurorehabilitation. AISN's AI-enhanced solution signals a paradigm shift, enabling scalable, adaptive, patient-centered recovery models.

Disclosure of interest: Adam Mierzwa: nothing to disclose

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 08.01 - CLINICAL PRACTICE, MANAGEMENT AND CARE

P2679 - ESOC2025-LB-426

MUSCULOSKELETAL RESPONSES TO HIGH-INTENSITY INTERVAL TRAINING IN INDIVIDUALS WITH CHRONIC STROKE: A STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL

Chen Xu¹, Yifeng Wang¹, Meizhen Huang¹

¹Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China

Background: Individuals with chronic stroke experience accelerated musculoskeletal aging, which cannot be solely attributed to neurological damage. Declines in muscle power (defined as the product of muscle force and velocity) post-stroke are more pronounced than declines in muscle strength and muscle mass, and are associated with reduced mobility and quality of life. Traditional exercise patterns in stroke rehabilitation using moderate-intensity continuous training (MICT) may not stimulate sufficient neuromotor control to promote gains in muscle power. High-intensity interval training (HIIT) could be a feasible alternative by involving repetitive bouts of near-maximal voluntary exertion.

Case Report / Trial: This is a three-arm, assessor-blind, stratified, randomized controlled trial. Sixty-six individuals with chronic stroke, aged 50–80 years and with normal or fair cardiac health (New York Heart Association Functional Classification Class I or II), will be randomly assigned to one of three groups: HIIT, MICT, or stretching exercise (active control), with three sessions per week for 12 weeks. HIIT and MICT sessions will be performed on a recumbent stepper at a tailored intensity based on each participant’s heart rate reserve and rating of perceived exertion.

High impact reason: This trial will provide novel insights into the efficacy of HIIT on musculoskeletal health in individuals with chronic stroke.

Results: The primary outcome is muscle power. Secondary outcomes include muscle strength, body composition (muscle mass and bone mineral content), biochemical markers (myokines and bone turnover markers), motor function, balance function, cardiopulmonary response, cardio-autonomic response, and psychosocial responses. Outcomes will be assessed at baseline, 12-week post-intervention, and 12-week follow-up.

Disclosure of interest: The authors declare no conflicts of interest.This study was conducted retrospectively. There was no funding.

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P2680 - ESOC2025-LB-502

DEVELOPMENT OF A COMMUNITY WATER-BASED THERAPEUTIC EXERCISE PROGRAM FOR STROKE SURVIVORS: A MODIFIED DELPHI STUDY

Olivia Manning¹, Jennifer Tomasone², Marcia Finlayson³, Vincent Depaul³

¹School of Rehabilitation Therapy, Queen’s University, Providence Care Hospital, Kingston, Canada, ²School of Kinesiology and Health Studies, Queen’s University, Kingston, Canada, ³School of Rehabilitation Therapy, Queen’s University, Kingston, Canada

Background: Upon discharge from formal rehabilitation, stroke survivors are encouraged to continue with exercise to maintain and continue to improve function. Yet, many are not sufficiently active and describe transitions to community as sudden and challenging. Inactivity can lead to many negative health outcomes. Water-based therapeutic exercise (WBTE) provides numerous benefits and can support the transition from formal rehabilitation to community exercise but remains underutilized, with no established evidenced-based guidelines for community implementation. This study aimed to identify key components of a community WBTE program for stroke survivors based on expert consensus.

Case Report / Trial: An online Modified Delphi study utilizing mixed methodology was conducted with 30 experts from various professional backgrounds with experience in stroke. Qualitative data was analyzed using generic coding, while quantitative data was analyzed based on established criteria for consensus outlined a priori.

High impact reason: Experts generated 18 recommendations that can be utilized as a non-prescriptive guide for future research and implementation of a community WBTE program for stroke survivors.

Results: Consensus was established with 24 experts completing two survey rounds. Consensus on various topics was achieved, including appropriate participants and personnel, intervention structure and content, and practical considerations. Experts recommended a level-based WBTE program in a group setting (30-45 minute sessions, 2x/week for 10-12 weeks). Experts highlighted the value of WBTE for stroke survivors and similar populations with varying abilities and recovery stages. However, they noted that successful implementation requires assessing equipment available and individual needs to determine the level and ratio of supports required.

Disclosure of interest: Erlan Yu: nothing to disclose. Chuanjie Wu: nothing to disclose. Jiaqi Luo: nothing to disclose. Xunming Ji: nothing to disclose.

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2681 - ESOC2025-LB-534

THE ROLE OF IMMATURE PLATELET FRACTION AS AN OUTCOME PREDICTOR IN STROKE: PRELIMINARY RESULTS FROM A TERTIARY HOSPITAL

Alexandra Tsankof^1,2, Dimitrios Tsakiris^3,4, Lemonia Skoura^3,5, Panagiota Tsiatsiou⁵, Eleftheria Ztriva¹, Michael Makris¹, George Ntaios^1,3, Christos Savopoulos^1,3, Georgia Kaiafa^1,3

¹First Propaedeutic Department of Internal Medicine & Acute Stroke Unit, AHEPA University Hospital, Thessaloniki, Greece, ²Intensive Care Department, AHEPA University Hospital, Thessaloniki, Greece, ³School of Medicine, Faculty of Health Sciences of Aristotle University, Thessaloniki, Greece, ⁴Hematology Department, University of Basil, Basil, Switzerland, ⁵Microbiology Department, AHEPA University Hospital, Thessaloniki, Greece

Background: The immature platelet fraction (IPF) has been reported as an indicator of arterial thrombus formation. Several biomarkers have been investigated as indicators of outcome in stroke. This study aims to investigate the use of IPF as a biomarker for predicting outcome in cerebrovascular events.

Case Report / Trial: Patients who presented with cerebrovascular events (type and TOAST classification) were studied, in whom IPF was measured upon admission (IPF1) and within 48 hours (IPF2). Patients were divided into 3 groups: 1st stroke episode who were not on prior antithrombotic treatment (group 1), 1st stroke episode who were on antithrombotic treatment for any other reason (group 2), and prior stroke within the previous year, under antithrombotic treatment (group 3). IPF values were correlated with the severity (based on NIHSS) and modified Rankin scale at discharge and at 6 months.

High impact reason: Based on these early results, IPF does not seem to be associated with severity, but it could perhaps be used as a predictor of outcome in ischemic stroke.

Results: A total of 62 patients were enrolled with a mean age of 81 years, 51.6% of them in the 1st group, 24.2% in group 2 and 24.2% in group 3. Regarding the type of stroke: 4.8% were hemorrhagic and 67.8% of ischemic etiology and 27.4% transient. No statistically significant correlation was found between IPF values and type or TOAST classification. No correlation was found between IPF and outcomes between groups. However, in ischemic stroke, the IPF1 was found to be related to the 6-month outcome (p<0.05)

Disclosure of interest: Chen, Jia-Hung: nothing to disclose. Chan Lung: nothing to disclose. Hu, Chaur-Jong: nothing to disclose.

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P2682 - ESOC2025-LB-547

MAESTOSO STUDY vs CHIMES STUDY: STROKE SEVERITY AT INCLUSION

Christopher L.H. Chen¹, Narayanaswamy Venketasubramanian², Romulo Esagunde³

¹National University of Singapore, Singapore, Singapore, ²Raffles Hospital, Singapore, Singapore, ³Jose R. Reyes Memorial Medical Centre, Manilla, Philippines

Background: MAESTOSO is a randomized double-blind placebo-controlled trial designed to evaluate the efficacy and safety of MLC1501 (a botanical product derived from precursors MLC601/MLC901, and containing only 4 herbal ingredients). The published CHIMES/CHIMES-E clinical program has already documented MLC601/MLC901 benefits in improving patients’s post-stroke recovery. MLC1501 was shown to increase neurite outgrowth and proliferation and has neuroprotective effects comparable to that of MLC601/MLC901: reduced LDH release, smaller infarct volume, and activation of ATP-dependent potassium channels. Before MAESTOSO, a clinical pharmacology program of MLC1501 was completed in Singapore and Australia documenting safety and lack of drug interactions.

Case Report / Trial: MAESTOSO (NCT05289947) is an international trial conducted under US-FDA IND, and its recruitment of 300 patients is now completed. Following an ischemic stroke, patients were randomized to receive either placebo, low-dose, or high-dose of MLC1501 and are treated for 6 months. Efficacy outcomes at week 12 and week24 include FMA, mRS, PROMIS-10 and NIHSS.

High impact reason:

Few pharmacological agents are available to improve patient’s recovery in the post-acute phase of stroke. The optimized composition of MLC1501, its pharmacology and the design of the trial conceived with the clinical experience gained in the CHIMES/CHIMES-E program suggest great potential for MLC1501 and make the results of MAESTOSO particulary important.

Results: Inclusion of patients with suffficient level of stroke severity and neurological deficit is paramount to maximize the chance of detecting a treatment effect with a neurorecovery agent. The characteristics of patients included in MAESTOSO will be presented, and compared with CHIMES, discussing how it may impact study results.

Disclosure of interest: No

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 05.03 - EPIDEMIOLOGY & RISK FACTORS

P2683 - ESOC2025-LB-555

INVESTIGATING THE INCIDENCE OF POST-STROKE DEPRESSION AND IDENTIFYING ITS RISK FACTORS AMONG PATIENTS ADMITTED TO Booali Sina Hospital, QAZVIN

Ali Emami¹, Seyed Ali Razavi², Monirsadat Mirzadeh³, Hossein Mozhdehi Panah⁴

¹Medical Doctor, Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran, Qazvin, Iran, ²Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran, Qazvin, Iran, ³Assistant Professor Community Medicine, Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran, Qazvin, Iran, ⁴Assistant professor, Department of Neurology, Booali Sina Hospital, Qazvin University of medical sciences, Qazvin, Iran, Qazvin, Iran

Background: Stroke is a major cerebrovascular event with significant physical and psychological consequences. Post-stroke depression (PSD) is a common complication, yet its risk factors remain underexplored. This study investigates the incidence of PSD following ischemic stroke and identifies associated risk factors among patients admitted to Booali Sina Hospital in Qazvin in 2024.

Case Report / Trial: A prospective cohort study was conducted on 127 ischemic stroke patients using convenience sampling. Data were collected through a checklist encompassing demographic characteristics, medical records, clinical features, and imaging findings. Depression severity was assessed using the Beck Depression Inventory (BDI), while stroke severity and disability were evaluated using the NIHSS and MRS scales, respectively. Statistical analysis was performed using SPSS version 19, with a significance level set at p < 0.05.

High impact reason: Understanding PSD's prevalence and risk factors is critical for improving patient outcomes and reducing post-stroke complications. Early identification and treatment of PSD can enhance recovery and quality of life.

Results: The mean age of participants was 70.13±15.84 years, with 52.8% experiencing right-hemisphere ischemic events. The mean BDI score was 23.94±12.72, indicating high depression prevalence: 19.7% normal, 15% mild, 27.6% moderate, and 37.8% severe depression. Significant correlations were found between BDI scores and NIHSS/MRS scores, hemisphere involvement, and employment status (p < 0.05). Logistic regression revealed that increased MRS scores were associated with higher depression severity. In conclusion, PSD is prevalent among ischemic stroke patients and significantly correlates with stroke severity, disability, hemisphere involvement, and employment status.

Disclosure of interest: Nan Cao, Lan Hong, Kun Fang, Jialiang Feng, Ming Hu, Cheng Huang, Qingyan Fu, Yang Zheng, Qundi Yang, Yuzhuo Wang, Yuankai Xie, Shunyao Wang, Xin Cheng, Qiang Dong: nothing to disclose

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 06.01 - PATHOPHYSIOLOGY OF STROKE / TRANSLATIONAL MEDICINE

P2684 - ESOC2025-LB-57

A MULTIMODAL INDIVIDUALIZED LONG-TERM INTERVENTION TO PREVENT FUNCTIONAL DECLINE AFTER STROKE. THE LAST-LONG TRIAL

Torunn Askim¹, Sara Rise Langlo^1,2, Elin Bergh^1,3, Øystein Døhl^1,4, Hanne Ellekjær^1,2, Anne Hokstad^1,2, Håkon Ihle-Hansen⁵, Bent Indredavik^1,2, Stian Lydersen¹, Geske Luzum¹, Yngve Seljeseth⁶, Toril Skandsen^1,2, Ingvild Saltvedt^1,2, Bente Thommessen³

¹Norwegian University of Science and Technology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, ²St. Olavs Hospital, Trondheim University Hospital, Trondhiem, Norway, ³Akershus University Hospital, Lørenskog, Norway, ⁴Trondheim Municipality, Trondhiem, Norway, ⁵Bærum Hospital, Bærum, Norway, ⁶Møre and Romsdal Health Trust, ÅLESUND, Norway

Background: The Stroke Action Plan for Europe recommends coordinated support after initial rehabilitation. However, the evidence for an optimal follow-up program remains insufficient. This trial investigated the effectivness of regular follow-up by a stroke coordinator.

Case Report / Trial: A pragmatic randomised controlled multi-centre trial was conducted from March 2019 to September 2024. Patients were randomized to intervention or standard care three months post-stroke with follow-up at 6, 12, and 18 months. Inclusion criteria were: age ⩾18 years, life expectancy ⩾12 months, modified Rankin Scale (mRS) score <5, vulnerable to functional decline (defined by other measures). In 18 monthly meetings, a community-based stroke coordinator identified the patients’ risk profile using a multidomain checklist. Idividual goals and actionpoints were defined accordingly. Mixed models were used to analyze differences between the groups for the primary (mRS) and the secondary (Barthel Index, Nottingham I-ADL, Montreal Cognitive Assessment, Trail Making Test A and B, and Short Physical Performance Battery) endpoints across the four time points.

High impact reason: This trial will provide evidence to guidelines regarding a coordinator-led personalized, multidomain approach to long-term follow-up after stroke.

Results: In total, 301 participants (48% women), with mean (SD) age; 71.3 (12.3) years, mean (SD) NIHSS admission score 3.38 (4.21), and mean (SD) mRS at inclusion 1.6 (0.9), were randomized to intervention (n=152) or standard care (n=149). At 18 months, the estimated difference (95% CI) between intervention and standard care was 0.03 (-0.16 to 0.22), p=0.789 for mRS. There were no differences between the groups for the secondary outcomes. ClinicalTrials.gov identifier: NCT03859063

Disclosure of interest: all authors: nothing to disclose.

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2685 - ESOC2025-LB-77

INTEGRATED UPPER LIMB AND LANGUAGE IMPAIRMENT AND FUNCTIONAL TRAINING (UPLIFT) POST-STROKE: A PHASE IIA ONGOING MULTICENTRE UMBRELLA TRIAL

Kathryn Hayward¹, Erin Godecke^2,3, Trevor Russell⁴, Julie Bernhardt⁵, Ruth Barker⁶, Vincent Thijs⁵, Sandra Brauer⁴, Geoffrey A. Donnan¹, Bruce Campbell¹, Leonid Churilov, Uplift Trial Collaboration¹

¹University of Melbourne, Melbourne, Australia, ²Perron Institute, Perth, Australia, ³Edith Cowan University, Perth, Australia, ⁴University of Queensland, Brisbane, Australia, ⁵The Florey, Melbourne, Australia, ⁶James Cook University, Cairns, Australia

Background: One in six stroke survivors continue to experience arm and communication disability at 3 months post-stroke. The aim of this study is to identify promising model(s) of integrated UPper limb and Language Impairment and Functional Training (UPLIFT) for people 3 to 24 months after stroke. It is hypothesised that at least one promising UPLIFT model of rehabilitation will be identified.

Case Report / Trial: Adaptive Phase IIa umbrella design that includes four simultaneous Bayesian Optimal Phase II (BOP) trials to evaluate individual UPLIFT interventions. The UPLIFT intervention is upper limb and language training (2 or 4 hours/day, 5 days/week for 4 weeks) delivered either in-person (severe stratum) or via telerehabilitation (mild-moderate stratum). Up to 160 adult participants will be recruited across five urban and regional hubs around Australia. Baseline and post-intervention assessments are blinded. Promising response is defined as a composite binary outcome combining promise of efficacy, safety, and feasibility. For each UPLIFT intervention, the proportion of participants with a promising response will be monitored at equally spaced, predefined interim stopping points (n=10/intervention). An intervention will be stopped if too few promising responses are observed. Registration: ACTRN12622000373774.

High impact reason: This novel early phase adaptive umbrella trial design presents a more efficient trial process to screen potential interventions. This design allows rigorous evaluation and will identify integrated UPLIFT intervention(s) with sufficient promise to take forward to a seamless Phase IIb-III trial.

Results: This ongoing multicentre (5 hubs across 4 Australian states) clinical trial has recruited 52 participants. Study completion is expected in early 2026.

Disclosure of interest: Founder and CEO of Avertto medical Ltd, Received funding from the Israeli innovation authority and EIC

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 05.02 - SECONDARY PREVENTION

P2686 - ESOC2025-LB-78

STANDARDISED ADAPTIVE MULTIPHASE PLATFORM FOR UNMET STROKE NEEDS ADAPTIVE PIPELINE-PLATFORM TRIAL (SEAMLESS-APPT)

Kathryn Hayward¹, Natasha Anne Lannin^2,3, Carlos Garcia-Esperon⁴, Mark Parsons, Amy Brodtmann², Hannah Johns¹, Vignan Yogendrakumar⁵, Eva Mistry⁶, Michael Hill, Bruce Campbell¹, Leonid Churilov, Seamless Adaptive Pipeline-Platform Trial Collaboration¹

¹University of Melbourne, Melbourne, Australia, ²Monash University, Melbourne, Australia, ³Alfred Health, Melbourne, Australia, ⁴Hunter New England Local Health District, Newcastle, Australia, ⁵The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Canada, ⁶University of Cincinnati, Cincinnati, United States

Background: Adaptive platform trials have been used to definitively evaluate effectiveness of multiple treatments across one or more subgroups of participants. The adaptive platform trial approach is yet to capitalise upon advantages provided by the phased nature of treatment identification and development in clinical trials. StandardisEd Adaptive Multiphase pLatform for unmEt Stroke needS trial is a novel Adaptive Pipeline-Platform Trial (SEAMLESS-APPT). This trial is designed to establish evidence of dose, safety and sufficient promise of efficacy (Phase I-IIa) before establishing efficacy/effectiveness (Phase IIb-III) within the structure of a master protocol with a priori defined adaptations. Our aim is to develop and maintain SEAMLESS-APPT to test innovative acute and recovery focused treatments for unmet stroke needs.

Case Report / Trial: SEAMLESS is an Adaptive Pipeline-Platform Trial with domain-specific treatment protocols. Each domain may be represented as a hierarchical combination of basket and/or umbrella components implementable at each phase of clinical trial conduct. Any basket component applies an adaptive master protocol to test a hypothesis of a treatment across multiple subpopulations. Any umbrella component enables hypothesis testing of various treatment within a domain-specific subpopulation. Prespecified rules govern transition between clinical trial phases and within phase adaptations.

High impact reason: SEAMLESS-APPT presents an innovative approach to platform trial design and conduct. The integration of the pipeline approach within a platform trial could deliver unprecedented efficiency to narrow the translational gap between evidence generation and clinical care.

Results: Development of the SEAMLESS-APPT infrastructure is ongoing and initial SEAMLESS domains are in preparation.

Disclosure of interest: Märit Jensen has received personal fees from BMS. The trial is funded by the European Union, the German Research Foundation and by the Australian National Health and Medical Research Council.

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 06.01 - PATHOPHYSIOLOGY OF STROKE / TRANSLATIONAL MEDICINE

P2687 - ESOC2025-LB-91

FIT 4 ME AFTER STROKE: AN INNOVATIVE TRIAL INVESTIGATING POST STROKE PHYSICAL ACTIVITY DOSE

Natalie Fini¹, Julie Bernhardt², Catherine Said^1,3,4, Gavin Williams^1,5, Erin Bicknell⁶, Ramage Emily^1,2, Christopher Tzefronis¹, Paul Fink¹, Coralie English^7,8, Leonid Churilov, Kathryn Hayward^1,2,9, on Behalf of the Fit4me Trial Collaboration¹

¹Physiotherapy Department, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia, ²Stroke Division, Florey Institute of Neurosciences & Mental Health, Heidelberg, Australia, ³Physiotherapy Department, Western Health, St. Albans, Australia, ⁴Australian Institute of Musculoskeletal Sciences, St. Albans, Australia, ⁵Physiotherapy Department, Epworth Healthcare, Richmond, Australia, ⁶Physiotherapy Department, The Royal Melbourne Hospital, Parkville, Australia, ⁷School of Health Sciences, University of Newcastle, Newcastle, Australia, ⁸Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, Australia, ⁹Melbourne Medical School, The University of Melbourne, Parkville, Australia

Background: Physical activity is important for secondary stroke prevention. The dose of physical activity necessary to achieve a benefit post stroke remains unknown. This trial aims to determine how much physical activity is safe, acceptable, feasible, whilst also looking for a signal of efficacy.

Case Report / Trial: This is a super-umbrella Bayesian Optimal Interval phase I/IIA trial with four sub-studies defined by physical activity intensity (light and moderate-vigorous) and walking speed (mild (>0.8m/s) and moderate (⩽0.8m/s) severity). Cohorts of five participants (<6-months post-stroke, able to ambulate) are sequentially enrolled in each sub-study guided by pre-defined dose escalation/de-escalation rules. A physical activity dose is deemed promising if it is tolerated by 20 participants. The intervention, co-designed with stroke survivors and clinicians, establishes a personalised physical activity program through shared decision-making that is administered over 6-months. Outcomes are collected at baseline, 8-weeks and 6-months. The decision to escalate/de-escalate physical activity dose is made at 8-weeks based on the desirability of a dose, demonstrated by ⩾20% improvement in daily step count, adherence to physical activity intensity and duration dose, and no serious intervention-related adverse events.

High impact reason: This super-umbrella trial will produce essential dose safety, feasibility and signal of efficacy data to guide a seamless Phase IIb/III trial investigating co-designed physical activity programs in stroke survivors.

Results: This ongoing trial across three sites in Melbourne Australia has recruited 18 participants. Study completion is expected by December 2026.

Disclosure of interest: nothing to disclose

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.03 - PROGNOSIS AND OUTCOME AFTER STROKE

P2688 - ESOC2025-LB-92

FUNCTIONAL OUTCOME PREDICTION IN ACUTE ISCHEMIC STROKE DUE TO MEDIUM OR DISTAL VESSEL OCCLUSIONS USING PROSPECTIVE, RANDOMISED MULTICENTRE DATA

Vera Aebischer¹, Ashraya Indrakanti¹, Joshy Cyriac², Nikki Rommers³, Marios Psychogios¹

¹Department of Neuroradiology, University Hospital Basel and University of Basel, Basel, Switzerland, ²Department of Research and Analysis, University Hospital Basel, Basel, Switzerland, ³Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland

Background: Medium or distal vessel occlusions (MDVO) account for 25–40% of acute ischemic strokes. Functional outcome prediction in MDVO patients is challenging, yet accurate prediction is crucial for patient counseling and rehabilitation planning. While machine learning (ML) models exist for large vessel occlusions, only a few have been developed for MDVOs using multicentre data.

Case Report / Trial: This study developed and compared different ML models to predict favorable or unfavorable modified Rankin Scale (mRS) scores after 90 days (mRS 0-2 v. mRS 3-6). Data was obtained from 540 patients enrolled in a multicentre, prospective, randomised trial. Models were trained using demographic, clinical, laboratory, and imaging features collected at admission, 24 hours, and 10 days after admission. Different feature selection methods and algorithms were compared at each timepoint. Performance was evaluated using accuracy, ROC-AUC, precision, recall, F1 score and Brier Score Loss.

High impact reason: This study is the first using prospective, randomised data to develop ML models for predicting functional outcomes in MDVO patients while comparing different algorithms and feature selection methods. It demonstrates that simpler algorithms with constrained sets of easily collectable features perform as accurate as more complex algorithms. This facilitates potential integration into routine clinical practice.

Results:Prediction accuracy improved significantly from admission (71.3%) to 24 hours (83.3%), with non-significant further gains at 10 days (88.0%). Simple logistic regression models with as few as three to five features (age, pre-stroke mRS, and NIHSS scores at admission and follow-ups) performed comparable to more complex algorithms (TabPFN, XGBoost) and larger feature sets.

Disclosure of interest: Nothing to disclose.

04.00 - DIAGNOSIS / ETIOLOGY - 05.03 - EPIDEMIOLOGY & RISK FACTORS

P2689 - ESOC2025-LB-208

SPINAL CORD ISCHEMIA IN CHILDREN AND ADOLESCENTS: THE EXPERIENCE OF A TERTIARY PEDIATRIC CENTER

Martino Diana¹, Matteo Mordeglia¹, Maria Savina Severino¹, Giulia Prato¹, Giulia Amico¹, Sara Signa¹, Marta Bertamino¹

¹Istituto Giannina Gaslini, Genova, Italy

Background: Ischemic spinal cord infarction (SCI) in children and adolescents is a rare and under-recognised condition. Unlike adults, where atherosclerosis and vascular abnormalities predominate, paediatric SCI arises from diverse aetiologies. The magnetic resonance imaging (MRI) has improved detection, but gaps remain in understanding the condition’s etiopathogenesis and optimal management.

Case Report / Trial: We conducted a retrospective review of 12 patients, from the neonatal period to 14 years old diagnosed between 2015 and 2024. Clinical data were retrieved from patients’ electronic charts, including thrombophilic and autoimmune panels, cerebrospinal fluid analysis, genetic testing, ADA2 enzymatic activity and COVID-19 immune profiling. MRI studies were reviewed by 2 pediatric neuroradiologists in consensus.

High impact reason: This study aims to describe the clinical and diagnostic features, aetiologies, and outcomes of 12 paediatric SCI cases managed at a tertiary paediatric care centre.

Results: Of the 12 cases (7 males, 58%, median age 6,67), 5 were idiopathic, with others attributed to fibrocartilaginous embolism in 1 case, neonatal hypoxic events in 3 cases, COVID-19-related aetiology in 1 case, previous trauma in 1 patient and cardiac arrest in a single case. Mean follow-up duration was 1 year and 4 months (5-24 months). Outcomes varied from complete recovery to residual motor and autonomic dysfunction (modified Ranking Score 1-5). Thrombotic and infectious investigations were non-contributory in most idiopathic cases.

We highlight the importance of comprehensive diagnostic evaluations, including imaging, thrombotic, and infectious work-ups in paediatric SCI. Further research is needed to refine therapeutic strategies and assess recurrence risks.

Disclosure of interest: Bo Song, Yuan Chai, Lulu Pei: nothing to disclose

04.00 - DIAGNOSIS / ETIOLOGY - 04.06 - CARDIOEMBOLISM & HEART-BRAIN INTERACTIONS

P2690 - ESOC2025-LB-256

PREVALENCE OF SIGNS AND SYMPTOMS IN POSTERIOR CIRCULATION ISCHEMIC STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Susanna Sammali^1,2, Danilo Caimano³, Anna Poggesi^1,2, Simone Vanni⁴, Fana Alemseged⁵, Francesco Arba¹

¹Stroke Unit, Careggi Hospital, Florence, Italy, ²NEUROFARBA Department, University of Florence, Florence, Italy, ³Neurology Unit, Department of Medicine, Nuovo Ospedale San Giovanni di Dio, Florence, Italy, ⁴Emergency Medicine, University of Florence, Florence, Italy, ⁵Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia

Background: Posterior circulation is a frequent localization of acute ischemic stroke (PCIS), Rapid diagnosis of this condition can be challenging as it often presents with non-specific symptoms. We performed a systematic review and meta-analysis to describe the prevalence of signs and symptoms in PCIS.

Case Report / Trial: Two databases (PubMed and EMBASE) were searched for English written observational studies reporting data on signs and symptoms in patients with a diagnosis of PCIS. Data were extracted by two independent researchers. We assessed the risk-of-bias (RoB) and calculated the pooled-prevalence and 95% confidence intervals using Random Effect models. We performed subgroup analyses according to type of diagnosis (clinical vs imaging) and location of lesion (cerebellar vs other) in each study.

High impact reason: In acute patients with PCIS, limb weakness, dysarthria, vertigo and nausea/vomiting were the most frequent presentations. Our results may inform clinicians and improve recognition of PCIS in the acute setting.

Results: 28 studies involving 3,462 patients were included in the study. RoB was generally medium/low, funnel plots indicated publication bias, in 18/28 studies diagnosis was performed on imaging. The most common signs were limb weakness (48%;95%CI 39%-58%) and dysarthria (48%;95%CI 37%-59%), while the least frequent was hemianopia (15%;95%CI 7%-25%). The most common symptoms were vertigo (41%;95%CI 30%-52%) and nausea/vomiting (41%;95%CI 32%-50%), while the least frequent was diplopia (9%;95%CI 6%-13%). Prevalence of signs and symptoms were similar between imaging and clinically diagnosed stroke; in patients with cerebellar stroke the most frequent sign was gait ataxia (70%;95%CI 56%-82%) and the most common symptom was vertigo (50%;95%CI 32%-68%).

Disclosure of interest: There are no conflicts of interest. NK, AS and IH are employees of Life Molecular Imaging who provided reagents for 18F-GP1 production.Beth Whittington is supported by the British Heart Foundation( FS/CRTF/21/24129). Michelle Williams is supported by the British Heart Foundation (FS/ICRF/20/26002, FS/11/014, CH/09/002), RG/16/10/32375, RE/18/5/34216). Marc Dweck is supported by the British Heart Foundation (FS/14/78/31020) and by the Sir Jules Thorn Biomedical Research Award 2015 (15/JTA). David Newby is supported by the British Heart Foundation (CH/09/002, RG/16/10/32375, RE/18/5/34216). Neil Craig is supported by the Medical Research Council (MR/Y009932/1). Craig Balmforth is supported by the Medical Research Council (MR/Y009770/1). Edwin van Beek is supported by the Scottish Imaging Network: A Platform of Scientific Excellence ( SINAPSE. Piotr Slomka are supported by NIH NHLBI grant 5R01HL135557. Will Whiteley is supported by the Chief Scientist’s Office, Alzheimer’s Society. Joanna Wardlaw is supported by the UK Dementia Research Institute which receives its funding from DRI Ltd, funded by the UK Medical Research Council, Alzheimer’s Society and Alzheimer’s Research UK.

04.00 - DIAGNOSIS / ETIOLOGY - 01.05 - NEUROINTERVENTION

P2691 - ESOC2025-LB-510

Left ventricular thrombus and cerebral infarction after acute anterior myocardial infarction: a prospective positron emission tomography study

Craig Balmforth¹, Beth Whittington¹, Evangelos Tzolos¹, Neil Craig¹, Michael McDermott¹, Norman Koglin², Andrew Stephens², Iris Hardewig², Michelle Williams¹, Edwin van Beek¹, Piotr Slomka³, Joanna Wardlaw¹, William Whiteley¹, David Newby¹, Marc Dweck¹

¹British Heart Foundation Centre of Research Excellence, University of Edinburgh, College of Medicine and Veterinary Medicine - Edinburgh - United Kingdom of Great Britain & Northern Ireland, Edinburgh, United Kingdom, ²Life Molecular Imaging, Berlin, Germany, Berlin, Germany, ³Cedars-Sinai Medical Centre, Los Angeles, United States of America, Los Angeles, United States

Background: Left ventricular (LV) thrombus formation predisposes to cardioembolic stroke and remains a diagnostic challenge. We aimed to explore the true incidence of LV thrombus and cerebral infarction in patients presenting with acute myocardial infarction using hybrid positron emission tomography (PET) and magnetic resonance imaging (MRI), with a thrombus-specific radiotracer, fluorine-18 GP1 ([¹⁸F]GP1), which binds to the glycoprotein IIb/IIIa receptor on activated platelets.

Case Report / Trial:In a prospective observational study, patients with acute anterior ST-segment elevation myocardial infarction underwent transthoracic echocardiography, gadolinium-enhanced cardiac and brain MRI and [¹⁸F]GP1 heart and brain positron emission tomography (PET)/MRI.

High impact reason: Hybrid [¹⁸F]GP1 PET/MRI is highly sensitive in detecting LV thrombosis and cerebral infarction, which often passes undetected and is substantially underestimated. [¹⁸F]GP1 PET holds major promise for better understanding the true incidence and pathophysiology of LV thrombus formation, as well as the determinants and rates of cerebral infarction after acute myocardial infarction.

Results: In 70 patients (61±8 years, 93% male) the incidence of LV thrombus was 3/70 (4%) by ECHO, 12/70 (17%) by MRI and 20/70 (29%) on [¹⁸F]GP1 PET (Figure 2). [¹⁸F]GP1 uptake was associated with lower ejection fraction and persistent ST-segment elevation (Figure 2). Acute cerebral infarction was detected in 9/70 patients (13%), with only one patient having a clinically apparent stroke. Two had evidence of LV thrombus on echocardiography, three had evidence on MRI, and five had evidence of LV [¹⁸F]GP1 uptake on PET (Figure 1). The relative risk of cerebral infarction in patients who had left ventricular [¹⁸F]GP1 uptake was 3.1 (0.98-9.75, p=0.107).

Disclosure of interest: Dr Caldwell has consulting agreements with Stryker Neurovascular, Route 92 Medical, Integral Diagnostics and Device Technologies. Dr Boo has consulting agreements with Stryker Neurovascular and Cerenovus. Dr Hussain has a consulting agreement with Stryker Neurovascular. Dr Priest has received consulting fees from Stryker and Medtronic. Dr Dabus has had consulting agreements with Cerenovus, Penumbra, Route 92, Medtronic, MicroVention, and Stryker and stock holdings in RIST and InNeuroCo. Dr Hanel has consulting agreements with Medtronic, Stryker, Microvention, Cerenovus, Balt, Phenox and an investor in InNeuroCo, Cerebrotech, Endostream, 3Rivers Medical, RIST Scientia, BlinkTBI, Bendit, ThrombX, Prometeus, Deinde, NeuroFine, Hyperion, REIST, Radical Catheters, Quantanosis, Iheal, Galaxy Therapeutics and CFI Neurolutions. No other disclosures.

04.00 - DIAGNOSIS / ETIOLOGY - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2692 - ESOC2025-LB-570

THE ROLE OF QUANTITATIVE ELECTROENCEPHALOGRAPHY IN STROKE PATIENT

Retnaningsih Retnaningsih¹, Aris Bintoro¹, Dian Prihananti¹, Reise Wirayudha¹, Virgi Maharani¹

¹RSUP Kariadi Semarang, Department of Neurology, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia, semarang, Indonesia

Background: QEEG is a tool that provides objective insights into brain function. Stroke induces significant alterations in brain wave activity, hemispheric asymmetry, power distribution changes, and connectivity impairments. QEEG offers a valuable method for assessing these abnormalities, aiding in early diagnosis, severity evaluation, and prognosis prediction.

Case Report / Trial: This retrospective cross-sectional study was conducted at Kariadi Hospital Semarang, analyzing QEEG data from stroke patients. Brain wave parameters such as Delta/Alpha Ratio (DAR), Alpha and Beta power reduction, and hypocoherence were assessed to determine correlations with stroke severity. Power spectrum analysis and connectivity impairments were evaluated using amplitude-integrated EEG (aEEG) and QEEG metrics.

High impact reason: Stroke exhibited higher delta power and an increased DAR, while mild stroke cases demonstrated relatively higher alpha power, indicating better neurological function. Increased theta power in the parietal region and reduced alpha power in the frontocentral region. Hypocoherence in the alpha and beta bands, particularly in the frontal, central, and parietal regions, indicated severe impairment in brain connectivity. A reduction in high-frequency bands (alpha, beta) correlated with worse long-term neurological outcomes.

Results: QEEG effectively detects stroke-related brain activity changes, providing insights beyond conventional EEG. Increased delta activity and DAR indicate cortical dysfunction, while reduced alpha and beta power reflect diminished cognitive and motor function. Hypocoherence suggests disrupted neuronal communication, contributing to post-stroke deficits. Early detection via QEEG facilitates timely interventions, potentially improving patient recovery and rehabilitation outcome.

Disclosure of interest: Funding. ISCIII PI18/00991.

04.00 - DIAGNOSIS / ETIOLOGY - 05.04 - STROKE COMPLICATIONS

P2693 - ESOC2025-LB-578

AI DETECTION OF MEDIUM VESSEL OCCLUSIONS: EVALUATING PERFORMANCE OF RAPIDAI VS VIZAI CT PERFUSION IN 1,591 CONSECUTIVE CODE STROKES

Harmeet Sachdev¹, Alison Hudson¹, Kenneth Ong¹, Susan Marklein², Maybelle Santos¹, Maria Flores¹

¹Good Samaritan Hospital, Dept. of Neurosciences and Stroke Center, San Jose, United States, ²Good Samaritan Hospital, Dept. of Radiology, San Jose, United States

Background:Identification of medium vessel occlusions (MeVOs) is challenging. We evaluated the accuracy of MeVO detection of with RapidAI and Viz.Ai CT Perfusion (CTP) software in consecutive code stroke patients at a comprehensive stroke center.

Case Report / Trial: Out of a total of 1,591 stroke alerts, 1,321 had both CTA and CTP, 14 cases were technically inadequate leaving 1,307 eligible cases (Male=607; Female=700; mean age = 69.9 years). 91 of these cases were MeVO positive based on radiology report/expert adjudication. Involved vessels were: M2/3 (49), A1/2 (12), P1/2 (22) and other (8).

High impact reason: RapidAI detected a higher percentage of MeVOs compared to Viz.Ai (93% vs 66%) on CTP and 98% on CTA + CTP. The substantial number of MeVOs missed by the Viz.Ai software could lead to delays in diagnosis and treatment.

Results: Rapid identified 85 MeVOs (93%) vs. 60 (66%) by Viz (P<0.0001). The mean Tmax>6 volume in MeVO positive cases was 37.6 ml (Rapid) and 21.6 ml (Viz), P <0.0001. Of the 6 MeVOs missed by Rapid on CTP, 4 were identified by Rapid CTA (vessel density map), resulting in a 98% MeVO capture rate by the Rapid stroke platform (CTA vessel density module not available from Viz).

Disclosure of interest: nothing to disclose

04.00 - DIAGNOSIS / ETIOLOGY - 01.05 - NEUROINTERVENTION

P2694 - ESOC2025-LB-594

THE IMPACT OF DIFFERENT CT PERFUSION SOFTWARE ON PATIENTS’ STRATIFICATION STRATEGIES IN ISCHEMIC STROKE

Alessio Sarnataro¹, Fabio Tortora², Edoardo Gragnano², Sirio Cocozza², Antonio Esposito², Cristina Di Monaco¹, Fiore Manganelli¹, Francesco Briganti²

¹Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Naples, Italy, ²Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy

Background:Different software to analyze Computed Tomography Perfusion (CTP) data in ischemic stroke patients are available. Assessing their comparability and interchangeability in clinical practice represent an only partly addressed question. Here we present a comparison between two distinct commercially available CTP software, analyzing their performance in estimating ischemic core volumes and evaluating the possible impact on patients’ stratification strategies to endovascular treatment (EVT).

Case Report / Trial:In this single-center retrospective monocentric observational study, 109 stroke patients (mean age=72.4±12.4 years, M/F=41/68) were included from January 2023 to June 2024. To evaluate the possible clinical relevance of the use of different software, DAWN and DEFUSE-3 criteria were applied to stratify the population. Two different software were compared (Viz.AI and syngo.via), and for both different relative CBF thresholds were used to define the ischemic core.

High impact reason:The two software showed significant differences in core volumes identification, independently from the used threshold (all comparisons with p<0.001). When the DAWN criteria for EVT were applied, the use of one software compared to another led to a significant (p=0.005) increase of subjects excluded from EVT. The use of a more conservative threshold significantly reduced (p=0.68) this discrepancy.

Results:Within-subject analysis of CTP data with different software and thresholds might lead to significantly different core estimation and treatment stratification in stroke patients. Although this effect can be mitigated using specific thresholds, physician should be aware of these differences when evaluating CTP data in clinical practice, given the possible direct implications in their decision-making process.

Disclosure of interest: S. Zejli; N. Chtaou; S. Bouchal; Z. Souirti; A. El Midaoui; M. F. Belahsen: nothing to disclose.

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 05.04 - STROKE COMPLICATIONS

P2695 - ESOC2025-LB-173

RANDOMISED TRIAL OF MILVEXIAN VERSUS PLACEBO IN ACUTE ISCHAEMIC STROKE AND TRANSIENT ISCHAEMIC ATTACK: RATIONALE AND METHODS FOR THE LIBREXIA-STROKE TRIAL

S. Clay Johnston¹, Graeme Hankey²

¹Department of Neurology, University of California, San Francisco, United States, ²Centre for Neuromuscular and Neurological Disorders, Medical School, The University of Western Australia, Perth, Australia

Background: Patients with ischaemic stroke (IS) or transient ischaemic attack (TIA) have high risk of subsequent IS despite antiplatelet therapy. Factor XIa inhibitors suppress thrombosis while preserving haemostasis. In the phase 2 AXIOMATIC-SSP trial in patients with acute IS or high-risk TIA, oral factor XIa inhibitor milvexian numerically reduced symptomatic IS across an 8-fold dose range with rates similar to placebo for the principal bleeding endpoint. No dose-response relationship with the primary composite endpoint (IS or MRI evidence of brain infarction) was observed.

Case Report / Trial: The ongoing, international, double-blind, placebo-controlled, phase 3 LIBREXIA-Stroke trial (NCT05702034) is addressing whether milvexian is superior to placebo in reducing the risk of subsequent IS among patients presenting acutely with IS or high-risk TIA. Patients with acute non-cardioembolic IS (NIHSS ⩽7) or high-risk TIA (ABCD² score ⩾6) are randomized within 48 hours of symptom onset to milvexian (25 mg BID) or placebo; all patients receive background antiplatelet therapy (Figure 1). The primary efficacy outcome is time to first occurrence of IS; the principal safety outcome is BARC 3c or 5 haemorrhage (intracranial, symptomatic intraocular, or fatal haemorrhage).

High impact reason: Milvexian may have a favourable risk-benefit profile in a large international population of patients with IS or high-risk TIA.

Results: For this outcome event-driven trial, it was estimated that ~15,000 subjects will be randomized in 47 countries (Figure 2) and followed until 909 primary efficacy outcome events occur to achieve 90% power to detect a 20% hazard reduction with milvexian.

Disclosure of interest: We will be sponsored by Royal Cornwall NHS Trust and have applied for further funding via NIHR Research for Patient Benefit Grant Funding. Dr Neha Kasaravalli: Nothing to Disclose, Dr Katja Adie: Nothing to Disclose, Professor Victoria Allgar: Nothing to Disclose, Dr Joanne Hosking: Nothing to Disclose, Professor Ken Poole: Nothing to Disclose, Dr Sanjeev Gupta: Nothing to Disclose, Ms Keren Menear: Nothing to Disclose, Dr Rachel Dennett: Nothing to Disclose, Miss Bianca Mills: Nothing to Disclose, Miss Verity Teague: Nothing to Disclose, Lisa Trembath: Nothing to Disclose, Helen Neilens: Nothing to Disclose

Figure 1.

Trial Overview

Figure 2.

Enrolling Territories

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2696 - ESOC2025-LB-193

STOPPING OR CONTINUING PLATELET INHIBITORS AFTER CRYPTOGENIC STROKE AT YOUNG AGE: THE STOP TRIAL

Anne Rasing¹, Mina Jacob¹, Nina Hilkens¹, Edo Richard¹, Frank-Erik De Leeuw¹, on Behalf of the Stop Trial Investigators¹

¹Radboud Institute for Medical research and Innovation, Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, Netherlands

Background: Young patients with cryptogenic stroke are prescribed lifelong antiplatelet therapy, based on extrapolation of results from trials including older patients. It is unknown whether antiplatelet therapy is effective in young patients without atherosclerosis, who are at low risk of recurrent ischaemic events. Yet, patients are exposed to an increased risk of serious bleeding complications. The aim of the STOP trial is to investigate whether antiplatelet therapy can safely be stopped three years after cryptogenic stroke/TIA at young age.

Case Report / Trial: The STOP trial is a multi-centre, prospective, randomised open-label, non-inferiority trial with blinded endpoint assessment. We aim to include 1316 patients with a first-ever cryptogenic ischaemic stroke/TIA at the age of 18-49 years, 3-10 years after their index event. Patients will be recruited from 28 Dutch hospitals. Patients will be randomised (1:1) to either stopping or continuing antiplatelet therapy with a follow-up period of 5 years. The primary efficacy outcome is a major vascular event (TIA, stroke, myocardial infarction, vascular death). The primary safety outcome is major bleeding. Secondary outcomes include quality of life and functional outcome.

High impact reason: If this trial demonstrates non-inferiority of discontinuation on recurrent vascular events, it would redeem many patients from taking antiplatelets daily and from a life-long confrontation with a disease they have suffered from years ago. It will also lead to a reduction of major bleedings contributing to improved quality of life and lower heathcare costs.

Results: The STOP trial has included the first participant in December 2024. The results are expected in 2032.

Disclosure of interest: Name of author : nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2697 - ESOC2025-LB-197

OPTIMAL BLOOD PRESSURE FOR THE PREVENTION OF MAJOR VASCULAR EVENTS IN STROKE PATIENTS (OPTIMAL - STROKE)

Gisele Sampaio Silva¹, Otavio Berwanger², Karla Santo¹, Octavio Marques Pontes-Neto³, Sheila Martins⁴, Adriana Conforto¹, Flavio Fuchs⁴, Joao Andrade¹, Maria Julia MacHline Carrion⁵

¹Hospital Israelita Albert Einstein, Universidade Federal de São Paulo, Sao Paulo, Brazil, ²The George Institute for Global Health, UK, London, United Kingdom, ³Faculdade Medicina de São Paulo ( FMUSP), Ribeirão Preto, Ribeirão Preto, Brazil, ⁴Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, ⁵epHealth, São Paulo, Brazil

Background: Despite evidence supporting antihypertensive use in ischemic stroke (IS) patients, guideline recommendations are limited by trial heterogeneity regarding optimal blood pressure (BP) targets and reduction intensity. The primary objective of the OPTIMAL-Stroke trial is to determine if a more intensive BP control target compared to the standard BP target in a population of patients with previous IS has an impact on the reduction of major cardiovascular events (MACE).

Case Report / Trial: OPTIMAL-Stroke is a randomized, controlled, 1:1 open-label trial with blind assessment of clinical outcomes. Patients were eligible if they are over 18 years and had a history of IS or transient ischemic attack, clinically stable for at least 48 hours prior to study inclusion and had a systolic BP of 130-180 mmHg. Sample Size-4060 patients.

High impact reason:. The OPTIMAL-Stroke trial is the largest worldwide study evaluating the impact of blood pressure levels on MACE in patients with previous IS.

Results: Patients were randomized to either an intensive BP control group targeting SBP <120 mmHg or to a control group, targeting SBP <140 mmHg. Outcome-The primary outcome is the first occurrence of a composite outcome of major cardiovascular events (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, hospitalization for unstable angina or hospitalization for heart failure). The analysis of primary efficacy outcome will be the comparison between the two groups using a long-rank test procedure. Trial Status-Enrollment is finished at 30 sites. A total of 4368 patients were randomized and are currently being followed.

Disclosure of interest: Sennur Delibas Kati: nothing to disclose, Firdevs Ezgi Ucan Tokuc: nothing to disclose, Beril Karacan: nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 03.03 - PROGNOSIS AND OUTCOME AFTER STROKE

P2698 - ESOC2025-LB-216

SYMPTOMATIC CAROTID OUTCOMES REGISTRY WITH MULTI-CENTER EVALUATION (SCORE)

Seemant Chaturvedi¹, Helmi Lutsep², Magdy Selim³, Brian Silver⁴, Luciano Sposato, Bijoy Menon⁵, Thanh N. Nguyen, Nishita Singh⁶, Rajiv Padmanabhan⁷, Curtis Benesch⁸

¹University of Maryland School of Medicine, Baltimore, United States, ²Oregon Health Sciences University, Portland, United States, ³Harvard Medical School, Boston, United States, ⁴University of Massachusetts School of Medicine, Worcester, United States, ⁵Calgary Health Sciences Center, Calgary, Canada, ⁶University of Manitoba, Winnipeg, Canada, ⁷Baystate Medical Center, Springfield, United States, ⁸University of Rochester School of Medicine, Rochester, United States

Background: Current treatment of symptomatic carotid stenosis relies on data that are more than 30 years old. There is no reliable information on the stroke rate with modern, intensive medical therapy. The aim of this pragmatic registry is to provide an estimate of the ipsilateral stroke rate for patients with 50-99% symptomatic carotid stenosis who have at least one feature suggesting reduced stroke risk.

Case Report / Trial: Intensive medical therapy (IMT) will be provided to all participants. IMT consists of dual antiplatelet therapy (short-term), high potency statins, blood pressure control, and lifestyle modification with risk factor education. Criteria for enrollment include any of three clinical or radiologic markers. Clinical 1) Women 2) Retinal ischemic event only 3) Last symptomatic event >1 week ago. Radiologic: 1) TCD negative for emboli 2) MRI negative for intraplaque hemorrhage 3) High risk TIA with negative DWI. Follow-up is one year.

17 centers in the US and Canada are approved for enrollment.

Primary endpoint: Ipsilateral ischemic stroke within 12 months of enrollment

High impact reason: The first registry in North America to evaluate modern medical therapy in symptomatic carotid stenosis.

Results: Study began enrollment in late 2022.

Sample size 114 patients

Enrollment as of Jan 2024: 56

SCORE Registry will provide valuable information on the stroke rate in patients with symptomatic carotid stenosis treated with intensive medical therapy. These data will allow clinicians to refine carotid stenosis decision making in symptomatic patients with >50% stenosis and potentially justify a future phase III RCT.

Disclosure of interest: nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 02.01 - INTRACEREBRAL HAEMORRHAGE

P2699 - ESOC2025-LB-249

HEROES PROJECT – TEACHING CHILDREN THE FIRST SYMPTOMS OF A STROKE

Asel Kerimkulova¹, Aliina Altymysheva¹, Nurlan Omorov¹, Francesca R. Pezzella¹

¹National hospital, Bishkek, Kyrgyzstan

Background: The FAST Heroes project aims to educate primary school children about the early signs of stroke and the importance of quick response in assisting elderly family members and others at risk. The project has been implemented in several schools across Bishkek and Osh, Kyrgyzstan, with participation from 24 schools and over 4,000 third-grade students.

Case Report / Trial: The project began with a series of training sessions and online meetings, including workshops for teachers, school administrators, and other stakeholders. Starting in December 2023, a series of events were organized, including webinars and in-person training, to ensure teachers were equipped with the necessary materials and knowledge to educate children. Teachers received a comprehensive package of educational materials, which was also translated into the Kyrgyz language.

High impact reason: Practical activities were incorporated into the project, where children learned the FAST method (Face, Arms, Speech, Time) for identifying stroke symptoms.

Results: This initiative emphasizes the importance of education in increasing awareness of serious health conditions such as stroke, empowering children with the knowledge to act swiftly in emergencies, and involving their families in the process. Ultimately, the FAST Heroes project aims to improve public health by saving lives and educating the next generation on how to promptly recognize and respond to stroke symptoms.

Disclosure of interest: Rongcai Jiang: This study was funded by the National Natural Science Foundation of China (No. 82311530117, 82271394, 82471497). The authors declare no competing interests. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Tao Liu: nothing to disclose. Zhihao Zhao: nothing to disclose.

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 06.02 - GENETICS, ‘OMICS AND BIOMARKERS

P2700 - ESOC2025-LB-378

OPIUM ADDICTION IN PATIENTS WITH LARGE VESSEL STROKE AND SMALL VESSEL STROKE: A CASE CONTROL STUDY

Mohammad Saadat Nia¹, Fariborz Khorvash¹, Foad Meraji Far¹, Maryam Kavousi¹

¹Isfahan University of Medical Sciences, Isfahan Neurosciences Research Center, Isfahan, Iran

Background: This study aimed to evaluate differences between the prevalence of opium addiction in stroke patients with large vessel (LVOS) and small vessel (SVS) and outcome of the disease.

Case Report / Trial: Method: This cross-sectional study in Isfahan, Iran (March 2023 - October 2024), assessed stroke patients using history, exams, and imaging and the prevalence of the opium addiction. Data on risk factors were collected. Patients received standard treatments, and follow-ups were conducted.

High impact reason: There is rare studies to show the effect of opium addiction in LVOS in comparison to SVS

Results: Among 200 subjects (50 LVOS, 50 SVS, 100 controls), opium addiction prevalence was 30% in LVOS, 10% in SVS, and 10% in controls. The significant difference (P-value=0.003) highlights the higher addiction rates among stroke patients specially LVOS. Additionally, addicted individuals had higher odds of worse outcomes on the modified Rankin Scale (mRS).

Conclusion: Our study reveals that opium addiction is more prevalent in LVOS patients compared to SVS patients. It also leads to increases significantly the risks of disability and mortality in stroke patients. Addressing the specific needs of opium-addicted patients through preventive and interventional strategies can improve stroke care and optimize patient outcomes.

Keywords: Stroke, Opium, Addiction, Outcome

Disclosure of interest: Nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 03.03 - PROGNOSIS AND OUTCOME AFTER STROKE

P2701 - ESOC2025-LB-383

INVESTIGATING THE PREVALENCE OF POST STROKE FATIGUE (PSF) IN ACUTE MINOR STROKE PATIENTS: AQUANTITATIVE ANALYSIS

Annuradhaa Ravi¹

¹Khoo Teck Puat Hospital, Singapore, Singapore

Background: Post-Stroke Fatigue (PSF) affects more than half of stroke survivors globally, negatively impacting Quality of Life (QoL). This study investigates the prevalence of PSF with minor acute stroke (AMS).

Case Report / Trial: This study investigates the prevalence of PSF in AMS patients and its associations with demographic and clinical factors at baseline and 6 weeks. Subjects aged 21-80 with NIHSS scores of 1-4, atleast supervison in ambulation with or without walking aids were recruited from Acute Stroke Unit, excluding those with PHQ-9 ⩾ 5, recurrent strokes, or communication deficits. Outcome measures included FSS and SF-36, with FSS scores > 4 indicating PSF.

High impact reason: PSF may negatively affect the QoL in patients with AMS. For healthcare providers to monitor and manage PSF in acute stroke management.It will also be useful in developing programs that addresses the PSF.

Results: Twelve subjects were recruited, with four completing follow-up. assessment. PSF was reported in 17% (2/12) and 50% (2/4) of the subjects at baseline and at 6 weeks,respectively. FSS scores for the non-PSF and PSF groups were 1.60 (0.87) and 5.33 (1.41)at baseline (p = 0.145); 1.72 (1.02) and 5.83 (1.02) at 6 weeks (p = 0.057), respectively. At 6weeks, positive correlations were found between FSS and SF-36 fatigue domain (r = 0.731,p =0. 006), SF-36 emotional domain (r = 0.665, p=0.018), and general health domains (r =0.671, p = 0.016). The results showed that PSF did affect the quality of life in subjects with AMS at 6 weeks despite the small sample size.

Disclosure of interest: Nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 05.03 - EPIDEMIOLOGY & RISK FACTORS

P2702 - ESOC2025-LB-408

Regular Physical Activity in Patients with Symptomatic Intracranial Arterial Stenosis: a Prospective, Randomized, Open-label, Blinded Endpoint trial

Wanwan Zhang¹, Chuanjie Wu¹, Zhengfei MA², Xunming Ji¹

¹Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China, ²Suzhou Municipal Hospital, Su Zhou, China

Background: Ischaemic stroke, primarily attributable to intracranial atherosclerotic stenosis (ICAS), is the leading cause of mortality and severe disability in China. Current primary treatments encompass pharmacological therapy and endovascular therapy; however, prior studies have demonstrated that the efficacy of these approaches is suboptimal, with the annual recurrence rate of ischaemic stroke due to ICAS remaining as high as 15–20%. Intriguingly, a retrospective study revealed that regular exercise could reduce the risk of stroke recurrence in patients with symptomatic ICAS. However, data from randomized, controlled trials are currently lacking. Therefore, we performed a randomized, controlled trial to assess whether regular exercise can reduce the annual recurrence rate in patients with symptomatic ICAS.

Case Report / Trial: In this randomized, open-label, blinded endpoint trial, 1300 eligible participants were randomly assigned to the the exercise intervention group or control group in a 1:1 ratio. The exercise intervention group received an individualised exercise programme and completed one year of moderate to high intensity aerobic exercise. All participants received health education on secondary stroke prevention. The primary endpoint was ischemic stroke events within 1 year.

High impact reason: This study focuses on patients with symptomatic ICAS, addressing the clinical challenge of their high recurrence rate. Through an innovative exercise intervention, this research not only provides a novel strategy for the precise treatment of ICAS patients, but also offers a new direction for the rehabilitation and management of patients with ischaemic stroke.

Results: By February 26, 2025, 440 participants have been enrolled.

Disclosure of interest: Retnaningsih: nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 03.02 - LIFE AFTER STROKE

P2703 - ESOC2025-LB-424

DEVELOPMENT AND VALIDATION OF PROGNOSTIC MODEL FOR PREDICTING ISCHAEMIC STROKE RECURRENCE IN PATIENTS WITH SYMPTOMATIC INTRACRANIAL ATHEROSCLEROTIC STENOSIS (PROMISE)

Xiao Dong¹, Chuanjie Wu², Chengbei Hou³, Yuanyuan Liu¹, Xunming Ji¹

¹Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China, ²Department of Neurology, Xuanwu Hosptial, Capital Medical University, Beijing, China, ³Center for Evidence-Based Medicine, Xuanwu Hospital Capital Medical University, Beijing, China

Background: Intracranial atherosclerotic stenosis is a prevalent cause of stroke worldwide and carries a high risk of recurrence. This study aimed to develop and validate a simple and effective model for predicting individualised risks of recurrent ischaemic stroke in patients with symptomatic intracranial atherosclerotic stenosis (sICAS).

Case Report / Trial: Data for this study were derived from RICA trial. The study outcome was ischaemic stroke recurrence. A total of 2995 participants with recent sICAS were included. The involved hospitals in RIC trial were non-randomly split into two groups (7:3), with 2137 participants (61 hospitals) forming the training set. Model development was based on a Cox model using the Akaike information criterion. Model validation was conducted internally through bootstrap resampling and externally on the other set comprising remaining 858 participants (23 hospitals). Model performance was assessed by discrimination (C-index), calibration (modified Hosmer-Lemeshow test and calibration plots), and clinical utility (DCA).

High impact reason: This model was developed using the largest dataset among studies on modeling the recurrence of ischaemic stroke of sICAS. Readily available variables in this model enables users to identify patients with high risk of recurrence accurately and practically. An online calculator was developed to further facilitate its clinical application.

Results: Eight variables were selected for the prediction model. The final model could accurately predict outcome in both internal (C-index = 0.81) and external (C-index = 0.78) validations. Model calibration was satisfactory across the full risk profile (modified Hosmer-Lemeshow test: χ²=5.32, p=0.38), and the DCA curves indicated clinical benefits. The web application is available at https://doc.xhedc.com/.

Disclosure of interest: Ali Emami: nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 05.02 - SECONDARY PREVENTION

P2704 - ESOC2025-LB-43

COMPARISON OF IOVERSOL AND IODIXANOL RELATED ADVERSE EVENTS IN CEREBROVASCULAR INTERVENTIONAL SURGERY (CAUSE): A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Aibin Guo¹, Zhiqi Yang¹, Bin Zhao¹, Yaxuan Wei¹, Yuan-Ming Li¹, Rong Yin¹

¹Gansu Provincial Central Hospital, Lanzhou, China

Background: There is ongoing debate regarding the comparative safety of iodinated contrast media (ICM)-related central nervous system (CNS) adverse events (AEs) between ioversol and iodixanol in cerebrovascular interventional surgery due to the lack of randomized studies. This study aims to compare the incidence of CNS AEs and evaluate the occurrence, extent, and risk factors of AEs associated with ioversol and iodixanol during cerebrovascular interventional surgery.

Case Report / Trial: We conducted a prospective study (Chi CTR 1900024679) involving 1,015 participants with suspected cerebrovascular diseases from July 2019 to July 2022. Participants underwent cerebrovascular interventional surgery with either iodixanol or ioversol administration. Data on ICM-related CNS AEs, other AEs, and participants' baseline information were collected.

High impact reason: To date, no substantial studies have been directed towards elucidating the frequency and severity of CNS AEs between LOCM and IOCM in this context.

Results: Out of 848 participants (mean age, 61.5 ± 12.6 years; 205 female) who received ICM, 16.7% (142 of 848) experienced CNS AEs. Ioversol was associated with a higher rate of CNS AEs compared to iodixanol (21.1% vs. 12.6%, P = 0.001). Logistic regression analysis revealed that history of allergic diseases was a risk factor for iodixanol-related AEs (odds ratio [OR], 2.5; 95% confidence interval [CI]: 1.2, 4.9; P = 0.01). Severe cerebral vascular stenosis (OR, 2.8; 95% CI: 1.8, 4.4; P< 0.001), female sex (OR, 0.5; 95% CI: 0.3, 0.8; P = 0.005) and relatively young (OR, 0.97; 95% CI: 0.95, 0.99; P = 0.004) were risk factors for ioversol-related AEs.

Disclosure of interest: David Seiffge: othing to disclose; Diego v. Werdt: nothing to disclose; Stefanie Abend: nothing to disclose; Urs Fischer: nothing to disclose; Lorenz Räber: Research support of the Swiss National Science Foundation, Abbott Laboratories, Boston Scientific

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 01.04 - THROMBOLYSIS

P2705 - ESOC2025-LB-466

Short-term Exposure to Air Pollution Significantly Associated With the Severity of Acute Ischemic Stroke

Nan Cao¹, Lan Hong¹, Kun Fang¹, Jialiang Feng², Ming Hu³, Cheng Huang³, Qingyan Fu³, Yang Zheng⁴, Qundi Yang⁴, Yuzhuo Wang⁴, Yuankai Xie⁵, Shunyao Wang², Xin Cheng¹, Qiang Dong¹

¹Huashan Hospital, Shanghai, China, ²Shanghai University, Shanghai, China, ³Shanghai Environmental Monitoring Center, Shanghai, China, ⁴Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China, ⁵School of Environmental and Chemical Engineering, Shanghai, China

Background: While associations between exposure to air pollution and the prevalence of acute ischemic stroke (AIS) have been investigated, only few studies have reported the relationship between air pollution and stroke severity. This study aimed to assess the impact of air pollution on AIS severity based on hourly monitoring data and a stroke-specific registry from 2017 to 2021 in Shanghai.

Case Report / Trial: Trial

High impact reason: This study comprehensively analyzed the impact of six major air pollutants (PM_2.5, PM₁₀, NO₂, CO, SO₂, and O₃) on AIS severity using hourly pollution monitoring data and a stroke-specific registry from 2017 to 2021 in Shanghai. By employing advanced statistical models, including conditional logistic regression model and a Quasi-poisson model coupled with distributed lag non-linear model (DLNM) and counterfactual analyses, the study identified significant associations between PM_2.5, PM₁₀, and SO₂ exposure and increased AIS severity.

Results: Conditional logistic regression model suggested that PM_2.5 (ER 2.31%, 95% CI 1.32-3.32%, P<0.001), PM₁₀ (ER 2.60%, 95% CI 1.97-3.23%, P<0.001), and SO₂ (ER 4.53%, 95% CI 3.37-5.70%, P<0.001) have the most significant effects on increased baseline NIHSS score, which remained robust in the two-pollutant model. Counterfactual analysis based on conditional logistic regression model revealed PRFs (PM_2.5 1.77%, 95% CI 0.86-2.68%, P<0.001; PM₁₀ 1.01%, 95% CI 0.28-1.73%, P<0.001; SO₂ 4.04%, 95% CI 3.04-5.03%, P<0.001). Quasi-poisson analysis showed similar results.

Disclosure of interest: All authors report nothing to disclose.

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2706 - ESOC2025-LB-481

Early treatment of Atrial fibrillation for Stroke prevention Trial in acute STROKE (EAST-STROKE)

Märit Jensen¹

¹University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Background: Acute stroke patients with atrial fibrillation (AF) have a particularly high risk of suffering from recurrent stroke and other cardiovascular complications. It is uncertain whether early rhythm control is effective and safe in preventing recurrent strokes and cardiovascular complications in patients with AF and an acute ischaemic stroke (AIS).

Case Report / Trial: EAST-STROKE is an international, randomized, controlled trial of early rhythm control in addition to usual care compared to usual care alone in patients with AIS and AF. A total of 1,746 patients will be randomized in Germany, Spain, the Netherlands, Switzerland and Australia. Further countries may join the trial.

The patients will be randomized to one of the following treatment arms:

1. Usual care + early rhythm control: Patients will receive usual care + early rhythm control, which will comprise antiarrhythmic drugs, ablation of AF, or cardioversion.

2. Usual care: Patients will receive usual care including oral anticoagulation, rate control, and treatment of cardiovascular risk factors following current guidelines.

The first primary outcome is a composite of first recurrent ischaemic stroke, haemorrhagic stroke, unclassified stroke, cardiovascular death, or hospitalization due to worsening of heart failure or due to acute coronary syndrome.

High impact reason: The results of EAST-STROKE will improve guidelines and change clinical practice and in doing so contribute to reducing the burden of death and disability from recurrent cardiovascular events in patients with AIS and AF worldwide.

Results: The clinical start of the trial is currently under preparation and the first patient is planned to be enrolled by summer 2025.

Disclosure of interest: Retnaningsih: nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2707 - ESOC2025-LB-509

PROGNOSTIC SIGNIFICANCE OF ATRIAL CARDIOPATHY IN PATIENTS WITH EMBOLIC STROKE OF UNDETERMINED SOURCE

Bo Song¹, Yuan Chai¹, Lulu Pei¹

¹the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

Background:Several cohort studies found atrial cardiomyopathy (AC) markers were risk factors for cardiovascular events. However, the current clinical trials demonstrated conflicting results about the anticoagulation therapy of embolic stroke of undetermined source (ESUS) with AC patients. Whether AC could be a predictor for ESUS deserves further investigation.

Case Report / Trial: This study was based on the Ischemic Cerebrovascular Disease Database of the First Affiliated Hospital of Zhengzhou University. We prospectively enrolled ESUS patients hospitalized within 7 days of onset from January 2019 to December 2021. AC was defined as N-terminal pro-brain natriuretic peptide >250 pg/ml, P-wave terminal force in lead V1>5000 µV·ms, or enlarged left atrial diameters. The adverse prognosis included stroke recurrence and all-cause death.

High impact reason: The results of our cohort study could provide ideas for the future trails. Perhaps the clinical trials should evaluate the atria function more comprehensively instead of using a single AC marker.

Results: Among 345 ESUS patients, the mean age was 59.22 ± 13.19 years, 69.0% were male, and 42.0% patients had AC. Overall, 56 patients had adverse prognosis, including 38 stroke recurrences during a median follow-up time of 18.1 months. The risk of adverse prognosis in patients with AC was higher than those without [18.1/100 person-years vs 3.9/100 person-years; hazard ratio (HR), 4.51; 95% confidence interval (CI), 2.46-8.26, P<0.001]. AC could increase 2.68 (adjusted HR, 3.68; 95%CI, 1.95-6.95, P<0.001) times of adverse prognosis in ESUS patients. The C statistic of CHA2DS2-VASc score + AC was higher than the CHA2DS2-VASc score (0.739 vs 0.652, P=0.008).

Disclosure of interest: Retnaningsih: nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2708 - ESOC2025-LB-522

Gene and clone size effects of clonal hematopoiesis in 1470 patients with cerebro- and cardiovascular diseases

Frederik Damm¹, Pelle Loewe¹, Paulina Strzelecka¹, Christopher-Maximilian Arends¹, Ira Rohrpasser-Napierkowski², Kai-Uwe Eckardt³, Frank Edelmann⁴, Ulrike Grittner⁵, Ulf Landmesser⁶, Knut Mai⁷, Lars Bullinger¹, Joachim Weber², Matthias Endres⁸

¹Department of Hematology, Oncology, and Cancer Immunology - CVK - Charité Universitätsmedizin BErlin, Berlin, Germany, ²Berlin Institute of Health, Berlin, Germany, ³Dept Nephrology - Charité - Universitätsmedizin Berlin, Berlin, Germany, ⁴Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology CVK, Berlin, Germany, ⁵Institute of Biometry and Clinical Epidemiology, Charité- Universitätsmedizin Berlin, Berlin, Germany, ⁶Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology CBF, Berlin, Germany, ⁷Department of Endocrinology and Metabolism, Charité- Universitätsmedizin Berlin, Berlin, Germany, ⁸Dept Neurology - Charité Hospital, Center for Stroke Research Berlin, Berlin, Germany

Background: Clonal hematopoiesis (CH), is recognized as a risk factor for cardiovascular disease (CVD).

Case Report / Trial: Here, we analyzed 1470 pts from a prospective longitudinal study who are at very high CV-risk. Patients with acute stroke (AIS; N=594), acute coronary syndrome (ACS; N=368), acute heart failure (AHF; N=131), acute kidney injury (AKI; N=176), and type 2 diabetes mellitus (T2DM; N=201) were investigated at baseline and 2-year follow up by targeted sequencing. Clonal expansion rates were estimated from longitudinal sequencing data.

High impact reason: This is the first study to compare CH and its impact on mortality across major vascular disease entities.

Results: Median age was 67 years and 494 (34%) pts were female. CH was detected in 616 (41.9%) pts. The most commonly mutated genes were DNMT3A, TET2, ASXL1, and PPM1D, 254 (17.2%) had multiple mutations. CH prevalence and mutational burden were associated with older age (p<0.001). While overall CH prevalence was not different between disease strata, gene-specific distribution was observed. Large CH clones (>VAF 10%, N=145) were associated with shorter survival after adjusting for age, sex, and history of CVD (HR=1.54, p=0.024). Similarly, CH with drivers other than DNMT3A was associated with increased risk of death (HR=1.57, p=0.003). Mutational burden showed a trend for shorter survival in multivariable regression analysis (HR=1.36, p=0.063).

CH was found in >40% with a distinct gene-specific distribution across disease strata. Gene mutation prevalence varies across different disease strata and VAF distribution varies between genes. Large clone size and non-DNMT3A CH were associated with shorter survival.

Disclosure of interest: Retnaningsih: nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 03.02 - LIFE AFTER STROKE

P2709 - ESOC2025-LB-526

SINGLE DOSE ADMINISTRATION OF ZOLENDRONIC ACID FOR PREVENTION OF BONE LOSS AFTER STROKE (BLAST): A FEASABILITY STUDY

Neha Kasaravalli¹, Katja Adie¹, Sanjeev Gupta¹, Bianca Mills¹, Rachel Dennett², Kenneth Poole³, Verity Teague¹, Keren Menear¹, Joanne Hosking², Victoria Allgar², Lisa Trembath¹, Helen Neilens²

¹Royal Cornwall Hospital, Truro, United Kingdom, ²University of Plymouth, Plymouth, United Kingdom, ³Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

Background: Stroke survivors are at risk of falls and fractures. Nearly two thirds fall and 8.4 percent sustain a fracture in the first year after a severe stroke. The fracture risk is not well assessed after stroke in clinical practice and adherence to oral bisphosphonate medication is usually lower in clinical practice than that observed in clinical trials. Therefore, we plan to conduct this feasibility study to investigate whether a single dose of zoledronate reduces the risk of 1) any fractures and 2) hip fractures in patients with hemiparesis after stroke.

Case Report / Trial: We aim to conduct a national, multi-centre, double blinded randomised controlled trial of zoledronate 5mg compared to placebo in a 1:1 ratio. The inclusion criteria will include 50 patients with new hemiparesis after clinical evidence of a stroke confirmed on CT or MRI. Feasibility analysis will be performed to inform data for a definitive trial.

High impact reason: BLAST will inform physicians of the acceptability and benefits of zoledronate to prevent fractures in high-risk stroke patients. We aim to disseminate our data and utilise this RCT for the basis of a future larger trial.

Results: The primary outcomes will be proportion of patients with fractures within 6 months post stroke. Other outcomes include quality of life, acceptability of intervention and functional status. Safety outcomes including morbidity, recurrent strokes and myocardial infarctions will be assessed.

Disclosure of interest: Torunn Askim: Nothing to disclose.

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 04.01 - DIAGNOSIS/INVESTIGATION OF STROKE ETIOLOGY

P2710 - ESOC2025-LB-549

THE EFFECT OF OBESITY IN STROKE COMPLICATIONS IN ICU PATIENTS AT RSUP DR. KARIADI HOSPITAL SEMARANG: A RETROSPECTIVE STUDY (2023-2024)

Retnaningsih Retnaningsih¹, Widhy Wardhani¹, Virgi Maharani^1,1, Reise Wirayudha^1,1

¹RSUP Kariadi Semarang, Department of Neurology, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia, semarang, Indonesia

Background: Stroke is a major cause of death and disability globally and in Indonesia. Obesity is suspected to contribute to stroke complications, especially in critically ill patients. This study aims to analyze the association between obesity and stroke complications in ICU patients at Kariadi General Hospital (2023-2024).

Case Report / Trial: This retrospective descriptive study analyzed medical records of stroke patients admitted to the ICU at Kariadi General Hospital from 2023 to 2024. Data included demographics, stroke type, nutritional status (obesity), length of stay, and clinical outcomes. Incomplete records were excluded.

High impact reason: Among 104 stroke ICU patients, 57.4% were obese. Obesity was significantly associated with male sex (p<0.05), ischemic stroke (p<0.05), diabetes (p<0.05), and dyslipidemia (p<0.05) but not with stroke recurrence, NIHSS, complications, or mortality (p>0.05). The most common complications were pneumonia (79.8%) and sepsis (74%).

Results: Ischemic stroke in ICU patients at Kariadi General Hospital Semarang was significantly affected by obesity, male sex, diabetes, and dyslipidemia. However, ischemic stroke did not considerably influence stroke recurrence, severity, complications, length of stay, or mortality. These findings highlight the complex role of ischemic stroke in critical stroke care.

Disclosure of interest: Retnaningsih: nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 09.01 - PRE-HOSPITAL SERVICE ORGANISATION

P2711 - ESOC2025-LB-556

EARLY CLOSURE OF LEFT ATRIAL APPENDAGE FOR PATIENTS WITH ATRIAL FIBRILLATION AND ISCHEMIC STROKE DESPITE ANTICOAGULATION THERAPY (ELAPSE): A MULTICENTER, PROSPECTIVE, RANDOMIZED, CONTROLLED, CLINICAL TRIAL

David Seiffge¹, Diego von Werdt¹, Stefanie Abend¹, Urs Fischer, Lorenz Räber², on Behalf of the Elapse Authors¹

¹Bern University Hospital, Inselspital, Department of Neurology, Bern, Switzerland, ²Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland

Background: Recurrent ischemic strokes despite optimal oral anticoagulation (“breakthrough strokes”) remain a significant burden for atrial fibrillation (AF) patients. This trial aims to determine whether combining percutaneous left atrial appendage occlusion (LAAO) with DOAC therapy reduces the risk for recurrent events compared to DOAC therapy alone in breakthrough stroke patients.

Case Report / Trial: ELAPSE is an international, multicenter, prospective, randomized, controlled, two-arm parallel-group, blinded endpoint-adjudicated, superiority, adaptive clinical trial (PROBE). It compares percutaneous LAAO plus DOAC to DOAC therapy alone in breakthrough stroke AF patients. Patients will be randomized in a 1:1 ratio to either the control group (DOAC therapy) or the interventional group (LAAO plus DOAC therapy). The initial sample size is set at 482 patients, with the possibility to increase to a maximum of 1000 patients, based on an interim analysis. The primary endpoint is a composite of recurrent ischemic stroke, systemic embolism, and cardiovascular death. Patients will be followed up every 6 months for a minimum of 6 months and up to a maximum of 54 months.

High impact reason: The ELAPSE trial will provide evidence on whether percutaneous LAAO offers suitable and effective secondary prevention for AF patients who have suffered a breakthrough stroke. Thus, this trial addresses a major unmet medical need for this patient population and has the potential to change future stroke guidelines for the benefit of patients.

Results: 15 patients (03.03.2025) have been randomized into the trial in Switzerland. Up to 45 sites in 8 countries will eventually be recruiting patients.

Disclosure of interest: Seyed Sina Ojaghi Haghighi: nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 04.01 - DIAGNOSIS/INVESTIGATION OF STROKE ETIOLOGY

P2712 - ESOC2025-LB-73

LACunar Intervention Trial 3 (LACI-3): EFFICACY AND SAFETY OF CILOSTAZOL AND Isosorbide mononitrate TO PREVENT ADVERSE OUTCOMES IN SMALL VESSEL (LACUNAR) ISCHAEMIC STROKE

Yulu Shi^1,2,3, Joanna Wardlaw^1,2,3, The Lacunar Intervention (Laci) Trial-3,Investigators^1,2,3

¹UK Dementia Research Institute, the University of Edinburgh, Edinburgh, United Kingdom, ²Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh, United Kingdom, ³Row Fogo Centre for Research into Ageing and the Brain, the University of Edinburgh, Edinburgh, United Kingdom

Background: 25% of ischaemic strokes are lacunar, due to intrinsic cerebral small vessel disease (SVD). There are no specific treatments to prevent adverse outcomes. Licensed drugs, isosorbide mononitrate (ISMN) and cilostazol have relevant effects and data. The LACunar Intervention Trial 1 (LACI-1) (n=57) and LACI-2 (n=363) confirmed trial feasibility, drug tolerability, and safety. LACI-3 aims to determine whether long-term oral ISMN and/or cilostazol reduces adverse outcomes after lacunar ischaemic stroke in a larger population.

Case Report / Trial: LACI-3 is an investigator-led, Phase III, prospective, randomised, controlled, open label, blinded outcome, multicentre, 2x2 partial factorial trial. It aims to recruit 1300 participants from 55-60 UK centres, treated for 18-months and overall duration 52 months. Patients with clinically-evident lacunar ischaemic stroke and compatible MR/CT are eligible. Interventions are oral ISMN (50mg OD or equivalent) and/or cilostazol (100mg BD), or neither. The primary endpoint is the 7-level scale for cognitive impairment at 18 months. Secondary endpoints include dependency, recurrent stroke, mood, quality of life, safety and health economics. LACI-3 is funded by UK National Institute for Health and Care Research Health Technology Assessment.

High impact reason: LACI-3 is the second-ever and only current Phase III trial in lacunar stroke or small vessel disease. ISMN and cilostazol are inexpensive, widely available and could be adopted rapidly if LACI-3 is positive.

Results: LACI-3 is being conducted with MHRA Scientific Advice to facilitate future licensing, has ethical and MHRA approval, started Site Initiation Visit, and will start randomisation in Spring 2025. 54 centres have expressed interest to participate.

Disclosure of interest: Harmeet Sachdev is a consultant for ISV. Alison Hudson: Nothing to disclose. Ken Ong: Nothing to disclose. Susan Marklein: Nothing to disclose. Maybelle Santos; Nothing to disclose. Maria Flores: Nothing to disclose.

06.00 - NOVEL TARGET/ EXPERIMENTAL FIDINGS TO CLINICAL TRANSLATION - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P2713 - ESOC2025-LB-343

CONTRALATERAL CEREBELLUM REDUCES GAMMA OSCILLATIONS UNDER NEURAL DYNAMICS AFTER ISCHEMIC STROKE: A TMS-EEG STUDY

Weili Jia¹, Yijun Zhou², Tao Liu, Zixiao Li¹

¹Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, ²Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China

Background:The effect of the cerebellum on neural activity in the contralateral motor cortex after ischemic stroke is unknown. Moreover, the effectiveness of the cerebellum as a regulatory target, especially after acute ischemic stroke, needs to be explored in depth.

Case Report / Trial:Twenty patients within two weeks after stroke and sixteen matched healthy controls (HCs) were included. The local mean field power (LMFP) and power spectral density (PSD) of the ipsilateral M1 when TMS targeted the ipsilesional primary motor cortex (ilM1-ilM1tar) and contralesional cerebellum (ilM1-clCbtar) were calculated. The relationship between PSD and the Fugl-Meyer assessment (FMA) was assessed using Spearman's correlation coefficient (r).

High impact reason:This study first used TMS combined with EEG as a quantitative tool to measure neural activity in the ilM1 while stimulating clCb to clarify the neurodynamic effect of the cerebellum on the neural activity of the cerebral cortex and its role in motor impairment after acute ischemic stroke.

Results:Compared with that of HCs, the LMFP of ilM1-ilM1tar in stroke patients decreased from 25–35 ms (t=2.17, P=0.045). In stroke patients, compared with the LMFP of ilM1-ilMtar, the LMFP of ilM1-clCbtar was significantly lower from 25–35 ms (t=2.13, P=0.046). The gamma PSD of ilM1-ilM1tar was -32.32±2.86 dB/Hz in HCs and -29.43±4.09 dB/Hz in stroke patients (t=-2.39, P=0.022). Compared with that of ilM1-ilM1tar, the gamma PSD of ilM1-clCbtar was significantly lower at 39–42 Hz in stroke patients (all P<0.05). Additionally, the gamma PSD of ilM1-clCbtar was negatively associated with FMA scores (r=-0.38, P=0.049) and FMA-lower extremity (LE) scores (r=-0.47, P=0.017).

Disclosure of interest: nothing to be disclosed

06.00 - NOVEL TARGET/ EXPERIMENTAL FIDINGS TO CLINICAL TRANSLATION - 04.01 - DIAGNOSIS/INVESTIGATION OF STROKE ETIOLOGY

P2714 - ESOC2025-LB-473

HIGH THROUGHPUT, MULTI-LABORATORY MODEL OF THROMBOEMBOLIC STROKE WITH THROMBOLYSIS: TE-MCAO

Michelle Lin¹, Mozammel Bhuiyan², Jessica Lamb², Karisma Nagarkatti², Marcio Diniz³, Karni Bedirian³, Abhishek Jha⁴, Anil Chauhan⁴, Mohammad Khan⁵, Ligia Boisserand⁶, Huaxin Sheng⁷, Bingren Hu⁸, Takahiko Imai⁹, Carly McCurry², Patrick Lyden²

¹Department of Neurosurgery, Keck School of Medicine at USC, LOS ANGELES, United States, ²Department of Physiology and Neuroscience, Keck School of Medicine at USC, Los Angeles, United States, ³Icahn School of Medicine at Mount Sinai, New York, United States, ⁴University of Iowa, Iowa City, United States, ⁵Augusta University, Augusta, United States, ⁶Department of Neurology, Yale University, New Haven, United States, ⁷Department of Anesthesiology, Duke University, Durham, United States, ⁸Department of Emergency Medicine, UCSD School of Medicine, San Diego, United States, ⁹Department of Anesthesiology, Massachusetts General Hospital, Boston, United States

Background: The filament model of middle cerebral artery occlusion (fMCAo) is simple and highly reproducible. The more biologically relevant thromboembolic model of teMCAo is difficult to standardize and less consistent across laboratories. In a multi-laboratory preclinical stroke network, we are developing a teMCAo model intended for high throughput treatment evaluation.

Case Report / Trial: From teMCAo models in the literature, we adapted and optimized blood donation/storage, surgery, thromboembolism, and thrombolysis. We inject a 5.0cm heterologous thrombus in Sprague-Dawley rats of both sexes. Recanalization is attempted with 1.5mg/kg Tenecteplase intravenously after 120min. Subjects are randomized to one of 5 treatments in a blinded, concealed matter. Imaging and behavior outcomes are analyzed centrally.

High impact reason: We seek a standardized, high-throughput teMCAo model for large, multi-laboratory pre-clinical stroke networks that test putative cerebroprotectants. So far, we standardized all procedures, including a method for preparing thromboemboli and using tenecteplase. It is feasible to deploy multiple treatments in a concealed fashion and collect blinded outcomes in hundreds of subjects. Lesion reproducibility across the laboratories must improve.

Results: This study is ongoing. So far 135 rats have been enrolled at 6 laboratories. Treatment compliance was excellent (97%) as was tenecteplase administration (98%). Day 3 mean lesion volume was 0.13±0.16 mm². Lesion heterogeneity in the intravenous control group ranged across the 6 laboratories: 0.02±0.00 (n=3) to 0.50±0.04 (n=4). The range in the IP control group was similar. Of the mITT group, 115 received all prescribed treatments, constituting the Fully Treated population. After treatment 59 (51%) died by Day 30.

Disclosure of interest: Nothing to disclose

06.00 - NOVEL TARGET/ EXPERIMENTAL FIDINGS TO CLINICAL TRANSLATION - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2715 - ESOC2025-LB-484

Improvement of neurological outcomes following Stroke in mice treated with a novel first-in-class compound

Quentin Marlier¹, Alexia Boreux¹, Arnaud Rives¹, Dario Mosca¹, Stéphane Silvente¹, Pierre Attali¹, Philippe Lefebvre¹, Nicolas Caron¹

¹Dendrogenix, avenue de l'hopital, 11, SPS B34 +3, 4000, Liège, Belgium

Background: Stroke is a leading cause of long-term disability and mortality worldwide. New strategies to mitigate the devastating consequences of this insult are urgently needed.

To investigate the therapeutic potential of our novel compound, we employed a comprehensive approach combining in vitro and in vivo models of ischemic stroke. Specifically, we used an oxygen glucose deprivation model (OGD) in vitro to stimulate ischemic condition in primary culture of mice cortical cells. We also used a middle cerebral artery occlusion (MCAO) model in vivo to induce ischemic stroke in male mice.

Case Report / Trial:

High impact reason:

Results: Our results demonstrate that our treatment restored 36,8% of the living neuronal cells in culture following 4h of OGD and 24h of reperfusion. To Transpose these data in vivo, we measured by Triphenyl tetrazolium chloride (TTC) staining the volume of the ischemic insult 48 hours following 1h of MCAO. We observed that our compound reduces the size of the lesion by 70%. Behavioral assessments have been performed before TTC staining to measure spontaneous locomotion (open field) and motor coordination (rotarod). Our molecule increased mice speed by 47% and restored motor coordination up to 73% compared to control mice.

These data indicate that our new compound act positively on neuronal circuitry responsible for motor behavior in a context of ischemic neuronal accident and suggest its potential as a therapeutic agent for stroke patients.

Ongoing protocol is now aiming at confirm DX243 benefit in another animal specie (rat), with long term morphometric (MRI) and functional evaluation (30 days).

Disclosure of interest: Phillip Ferdinand: Nothing to disclose. Wing To: Employee of Firstkind Ltd. David Wells: Nothing to disclose. Anand Pandyan: Partnership with the Manufacturer (Firstkind Ltd). Alpesh Amin: Speaker and/or consultant for Pfizer, Salix, Alexion, AstraZeneca, Bayer, Ferring, Seres, Spero, Eli Lilly, Nova Nordisk, Gilead, Renibus, GSK, Dexcom, Reprieve, HeartRite, Aseptiscope unrelated to this study. Martyn Lewis: Nothing to disclose. Brin Helliwell: Nothing to disclose. Kieron Day: Employee of Firstkind Ltd. Christine Roffe: Joint research grant with Firstkind Ltd.

06.00 - NOVEL TARGET/ EXPERIMENTAL FIDINGS TO CLINICAL TRANSLATION - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P2716 - ESOC2025-LB-543

MONOCYTE CHEMOATTRACTANT PROTEIN-1 AS A BIOMARKER IN ACUTE ISCHEMIC STROKE: A PROSPECTIVE PILOT STUDY

Eleftheria Ztriva¹, Iraklis Moschonas², Alexandros Tselepis², Dimitris Lambrou¹, Alexandra Tsankof³, Michael Makris¹, Vasileios Patriarcheas¹, George Ntaios¹, Christos Savopoulos¹, Georgia Kaiafa¹

¹First Propaedeutic Department of Internal Medicine and Acute Stroke Unit, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece, ²Atherothrombosis Research Centre/Laboratory of Biochemistry, Department of Chemistry, University of Ioannina, Ioannina, Greece, ³Intensive Care Department, AHEPA University Hospital, Thessaloniki, Greece, Thessaloniki, Greece

Background: Monocyte chemotactic protein-1 (MCP-1) plays a crucial role in the inflammatory processes in atherosclerosis and is associated with an increased risk of stroke. However, there is limited data regarding the role of MCP-1 as a biomarker for predicting the severity and outcomes of acute ischemic stroke (AIS). This prospective case-control study aims to investigate whether MCP-1 levels are elevated in AIS, whether they vary among different stroke subtypes, and their potential utility in assessing stroke severity and predicting patient outcomes.

Case Report / Trial: MCP-1 levels were quantified using ELISA in patients with AIS or transients ischemic attack (TIA), and healthy participants. Stroke severity was assessed using the NIHSS score.

High impact reason: This prospective study provides preliminary evidence that MCP-1 levels are significantly elevated in AIS and are associated with changes in NIHSS scores during hospitalization. These findings support the potential of MCP-1 as an early biomarker for assessing the severity of AIS and predicting patient outcomes. Further studies with larger sample sizes are required to validate these results.

Results: A total of 32 patients with AIS or TIA were compared to 13 healthy controls. MCP-1 levels were found to be significantly elevated in stroke patients compared to healthy controls (p<0.001). No significant differences in MCP-1 levels were observed between AIS and TIA patients, nor across different stroke subtypes. A positive correlation was observed between MCP-1 levels and changes in NIHSS scores from admission to discharge (b=0.376, p<0.05), suggesting a potential relationship between MCP-1 levels and stroke severity over time.

Disclosure of interest: Anne van der Meij: nothing to disclose, Marianne van Walderveen: nothing to disclose, Nyika Kruyt: nothing to disclose, Erik van Zwet: nothing to disclose, Adriaan van Es: nothing to disclose, Kilian Treurniet: nothing to disclose, Eric Liebler: nothing to disclose, Michel Ferrari: nothing to disclose, Marieke Wermer: nothing to disclose.

07.00 - DIGITAL TRANSFORMATION, AI AND ROBOTICS - 05.02 - SECONDARY PREVENTION

P2717 - ESOC2025-LB-309

DEVELOPING A RADIOMICS-BASED MACHINE LEARNING MODEL FOR PREDICTING EARLY NEUROLOGICAL DETERIORATION IN PONTINE BRANCH ATHEROMATOUS DISEASE

Xin Ding¹, Yang Du¹, Yinglin Liu¹

¹Chengdu Second People's Hospital, Chengdu, China

Background: Branch atheromatous disease (BAD) is a prevalent subtype of acute ischemic stroke, with pontine paramedian artery (PPA) lesions exhibiting a higher likelihood of early neurological deterioration (END). This study aims to construct machine learning (ML) models based on radiomics features, with or without clinical features, to predict END in PPA-BAD patients, compare their performance, and explore the potential significance of radiomics features.

Case Report / Trial: Retrospective cohort study

High impact reason: This study leverages machine learning and radiomics to predict early neurological deterioration in pontine branch atheromatous disease

Results: This study included 183 patients with acute PPA infarction, extracting 1,887 radiomics features through detailed analysis of DWI images. Radiomics features were selected using LASSO regression, and clinical features were identified via intergroup comparisons. Multiple ML models, including linear discriminant analysis (LDA), logistic regression, decision trees, support vector machines, and neural networks (NN), were constructed. Model performance was assessed using ten-fold cross-validation, calculating AUC, sensitivity, and specificity, and models were further interpreted using Shapley values.

Among the models based on radiomics features, the LDA model demonstrated superior performance in the test set, achieving an AUC of 0.8924, a sensitivity of 0.750, and a specificity of 0.833. Incorporating clinical features into ML models, the NN model achieved a slightly higher AUC (0.8958) and sensitivity (0.792), with minimal change in specificity (0.833). In the radiomics feature-based LDA model, the GLSZM feature of lesion size nonuniformity, identified by Shapley values, provided the highest positive contribution to predicting END.

Disclosure of interest: Yulu Shi and Joanna Wardlaw on behalf of The LACunar Intervention (LACI) Trial-3 Investigators: nothing to disclose

07.00 - DIGITAL TRANSFORMATION, AI AND ROBOTICS - 07.01 - TECHNOLOGY INNOVATIONS: ROBOTS, VIRTUAL REALITY, ARTIFICIAL INTELLIGENCE AND MORE

P2718 - ESOC2025-LB-403

USE OF THE ORCITI DEVICE IN THE GAIT OF PEOPLE WITH STROKE

Sergio Rodriguez Menéndez¹, Claudia Garcia Santos¹, Cristina Garcia Lara¹, Héctor Cancio-Donlebun Blanco¹

¹INYPEMA, University Clinic of the Faculty Padre Ossó, Oviedo, Spain

Background: People with stroke have a gait disturbance that affects them in the reduction of walking speed and decreased balance and speed to make turns.The clubfoot is one of the factors that most affect people with stroke. ORCITI is a modular portable robotic antiequine, which adapts so that people can perform their daily activities. The aim of the present study was to analyze gait and balance ability with the ORCITI antiequinus in people with clubfoot stroke.

Case Report / Trial:A prospective cross-sectional descriptive observational study. The participant recruitment model was by non-probabilistic convenience. Inclusion criteria were age of majority, diagnosis of stroke, ability to walk and problems in the swing phase of gait.

All participants were evaluated without antiequinus, with a footup and with the ORCITI device with the following tools: Timed Up and Go test, Gait Assessment and Intervention Tool Scale, Timed 25 Foot Walk, and PIADs of comfort with support product.

High impact reason: The use of low-cost portable robotic devices can facilitate the walking patterns of people with stroke and thus increase the level of participation in their daily lives.

Results: The final results have not yet been analyzed because we still have 15 days to finish the evaluation of the sample. Preliminary results show that people with stroke have better walking test times with the ORCITI device than without it.

Disclosure of interest: This is an academic investigator-initiated trial funded by the Medical Research Future Fund (MRFF) of Australia Cardiovascular Mission (MRF2007425). B Campbell & L Churilov are joint senior authors. The authorship collaboration declare no direct conflicts related to this publication.

08.00 - QUALITY OF LIFE - 08.01 - CLINICAL PRACTICE, MANAGEMENT AND CARE

P2719 - ESOC2025-LB-436

“The impact of the severe consequences of a stroke on family members providing care.”

Meirgul Assylbek¹, Mariya Anartayeva², Nazira Zharkinbekova³, kanatzhan kemelbekov⁴

¹Department: “Social health insurance and public health” South Kazakhstan Medical Academy, Department of Neurology, Psychology, Neurosurgery and Rehabilitation, SHYMKENT, Kazakhstan, ²Department: “Social health insurance and public health” South Kazakhstan Medical Academy, Shymkent, Kazakhstan, ³Department of Neurology, Psychiatry, Rehabilitation and Neurosurgery, JSC South Kazakhstan Medical Academy, Shymkent, Kazakhstan, ⁴Department “Pediatrics-1”, JSC South Kazakhstan Medical Academy, Shymkent, Kazakhstan

Background: The purpose of the survey is to gather information about the quality of life and the challenges faced by family members in caring for relatives who have experienced a stroke and are receiving home care (see description).

Case Report / Trial: Based on the analysis of responses from the relatives of patients who have suffered a stroke, several conclusions can be drawn, and specific measures can be proposed to improve the situation. The study results underscore the need for psychological support and training in stress coping strategies, which has laid the groundwork for developing a program to enhance psychological assistance through tele-rehabilitation, planned for implementation on the website: https://rehabhome.kz.

High impact reason: These conclusions and recommendations can aid in the development of policies and programs aimed at improving the quality of life for both patients and their relatives, ensuring a comprehensive approach to caring for individuals who have suffered a stroke.

Results: Relatives of patients who engaged in continuous rehabilitation and utilized tele-rehabilitation reported significantly better quality of life outcomes (χ²= 64.0002, df=6, p=0.000000). The emotional and psychological states of respondents were found to differ significantly (p<0.005) from those who do not receive or infrequently access rehabilitation services (χ²= 51.4600, df=6, p=0.000000). Analysis of survey data using Kruskal-Wallis ANOVA by Ranks indicated that the overall response scores varied significantly (p<0.005) among groups categorized by familial relationships (H (9, N=287) = 110.3189, p<0.001).

Disclosure of interest: This is an academic investigator-initiated trial. B Campbell and L Churilov are joint senior authors. The authorship collaboration declare no direct conflicts related to this abstract.

09.00 - PRE-HOSPITAL SERVICE ORGANISATION - 09.01 - PRE-HOSPITAL SERVICE ORGANISATION

P2720 - ESOC2025-LB-210

PREHOSPITAL TRIAGE OF PATIENTS WITH A SUSPECTED ACUTE STROKE (PRESTO-2): DEVELOPMENT, IMPLEMENTATION AND EVALUATION OF A DECISION SUPPORT TOOL

Naomi de Ruijter¹, Femke Kremers¹, Ruben van de Wijdeven¹, Esmee Venema², Patrick van der Geest³, Johannes Ijzermans⁴, Merel Willeboer⁴, Kirsten Dorresteijn⁵, Annemarie Wijnhoud⁶, Henk Kerkhoff⁷, Diederik Dippel¹, Bob Roozenbeek¹

¹Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands, ²Department of Emergency Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands, ³Ambulance Rotterdam-Rijnmond, Barendrecht, Netherlands, ⁴Ambulance Service Zuid-Holland Zuid, Papendrecht, Netherlands, ⁵Department of Neurology, Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands, ⁶Department of Neurology, IJsselland Hospital, Capelle aan den IJssel, Netherlands, ⁷Department of Neurology, Albert Schweitzer hospital, Dordrecht, Netherlands

Background: Prehospital triage of suspected stroke patients aims to eliminate the need for interhospital transfers for patients with ischaemic stroke caused by a large vessel occlusion (LVO) eligible for endovascular thrombectomy (EVT), reducing onset-to-groin-time and improving long-term functional outcome. This can be facilitated with prehospital stroke scales, but these instruments use crude cut-points and do not account for important characteristics other than stroke severity. We aim to implement and evaluate a novel decision support tool, which provides a personalized triage advice by incorporating the RACE-scale, onset-time, GPS-based driving times, hospital-specific workflow metrics and time-dependent treatment effects.

Case Report / Trial: We developed the Stroke Triage App, a medical device which will be provided to paramedics. The app will be implemented in two ambulance regions in the Netherlands, encompassing ±1,800,000 inhabitants. The app provides an advice by comparing probability of good functional outcome (mRS0-2) between transportation to the nearest primary stroke center or directly to the thrombectomy-capable center further away. The primary outcome will be difference in onset-to-groin-time before and after implementation, compared to a control region with a difference-in-differences linear regression analysis.

High impact reason: We expect that the implementation of the Stroke Triage App will reduce onset-to-groin times in patients with LVO ischaemic stroke, which translates in better functional outcomes.

Results: The Stroke Triage App has been developed and CE-certified (class I medical device). Patient enrollment is ongoing since January 22^nd 2024. We plan to include ±3,000 stroke patients until 31^st December 2025.

Disclosure of interest: This is an academic investigator-initiated trial funded by a Stroke Foundation of Australia EMCR Seed Grant (EMCRSeed 2022), National Health and Medical Research Council Investigator Grant (2026151), University of Melbourne Catalyst Grant and a Stroke Trial Centre of Research Excellence to Accelerate Innovation and Translation Seed Grant. The authors declare no direct conflicts related to this publication. LC & KH are co-senior authors.

09.00 - PRE-HOSPITAL SERVICE ORGANISATION - 03.03 - PROGNOSIS AND OUTCOME AFTER STROKE

P2721 - ESOC2025-LB-577

Race score, a good predictor of large vessel occlusion in acute ischemic stroke, especially in underdeveloped countries

Seyed Sina Ojaghi Haghighi¹, Radnoosh Pashmforoosh², Mehdi Afkar³

¹Farhikhtegan hospital, Tehran, Iran, ²Neurology department, Tehran medical sciences Islamic Azad University, Farhikhtegan Hospital, Tehran, Iran, ³Tehran Medical sciences Islamic Azad University, Bu-Ali hospital, Tehran, Iran

Background: Stroke is the world's second most common cause of death and third main cause of disability. Patients with large vessel occlusion have twice the risk of disability as other stroke patients and account for 95% of post-ischemic stroke fatalities. Mechanical thrombectomy is necessary for the best possible therapy outcomes in these patients. However, the scarcity of MT-equipped clinics emphasises the importance of an efficient prehospital triage approach to reduce treatment delays and improve patient outcomes.

Case Report / Trial: This cross-sectional study included ischaemic stroke patients who visited three Tehran hospitals between 2023 and 2024. Demographic data, time from symptom onset to hospital admission, and RACE score were investigated. Patients' eligibility for intravenous thrombolysis (IV tPA) and MT was established using indication criteria.

High impact reason: Due to limited availability of MT-equipped centres and the important need for early treatment, identifying suitable patients during prehospital triage is critical. The RACE score, which has a sensitivity of 66%, and specificity of 72%, for detecting LVO, can be an effective prehospital screening tool.

Results: Out of 105 patients, 37.14% had a RACE score of 5 or above, indicating a significant risk of LVO. The average time from symptom onset to hospital admission was 55.8 hours, with only 16.2% of patients admitted within 4.5 hours and 23.2% within 6 hours of symptom onset. Overall, 7.1% of patients indicated for IV tPA therapy, and 10.1% of patients met the criteria for MT. Notably, delayed hospital attendance posed a significant impediment to prompt action.

Disclosure of interest: MP: Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783), ICARUS (32003B_220118) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Grants for the DISTAL trial from Stryker Neurovascular Inc., Medtronic Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc., Sponsor-PI SPINNERS trial (Funded by a Siemens Healthineers AG Grant), Research agreement with Siemens Healthineers AG, Local PI for the ASSIST, EXCELLENT, TENSION, COATING, SURF and ESCAPE-NEXT trials. Speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. VA, AI, JC, and NR: nothing to disclose

Poster Session I - LATE BREAKING ABSTRACTS

02.00 - INTRACRANIAL HEMORRHAGE - 02.01 - INTRACEREBRAL HAEMORRHAGE

P481 - ESOC2025-LB-100

EFFECTS OF COLCHICINE ON COGNITIVE OUTCOMES IN PATIENTS WITH ACUTE ICH: PRE-DEFINED SECONDARY ANALYSIS OF THE COVASC-ICH TRIAL

Ashkan Shoamanesh¹, Kelvin Ng¹, Thalia Field², Aravind Ganesh³, Joanna Schaafsma⁴, Shirin Jalini⁵, Ashfaq Shuaib⁶, Lauren Mai⁷, Amy Yu⁸, Laura Gioia⁹, Regan Cooley¹⁰, Dar Dowlatshahi¹¹, Angela Wang¹, Mike Sharma¹, Aristeidis Katsanos¹

¹McMaster University/ Population Health Research Institute, Hamilton, Canada, ²University of British Columbia, Vancouver, Canada, ³University of Calgary, Calgary, Canada, ⁴University of Toronto/ University Health Network, Toronto, Canada, ⁵Queen's University, Kingston, Canada, ⁶University of Alberta, Edmonton, Canada, ⁷Western University, London, Canada, ⁸University of Toronto/ Sunnybrook Research Institute, Toronto, Canada, ⁹Centre hospitalier de l'Université de Montréal, Montreal, Canada, ¹⁰University of Saskatchewan, Saskatoon, Canada, ¹¹University of Ottawa, Ottawa, Canada

Background: Colchicine may improve cognition in ICH survivors by reducing perihematomal inflammation and progression of microvascular brain injury.

Case Report / Trial: CoVasc-ICH (NCT05159219) is a phase II randomized vanguard trial that assessed the feasibility of a multicentre study evaluating colchicine 0.5mg once daily vs. placebo for the primary endpoint of major adverse cardiovascular events in patients with ICH presenting within 48 hours of symptom onset. The primary efficacy outcome for this pre-planned secondary analysis is the mean telephone Montreal Cognitive Assessment (t-MoCA) at 6 months following randomization. Secondary outcomes include mean t-MoCA at end-of-study.

High impact reason: CoVasc-ICH provides the requisite feasibility metrics and estimates of colchicine’s effects on cognitive outcomes following ICH to assist in the design of a pivotal randomized trial. Results of this vanguard suggest colchicine, a low-cost widely available treatment, may improve cognition following ICH.

Results: CoVasc-ICH enrolled 100 patients (mean age: 68 years; 41% female) with mean follow-up of 337 days. Baseline imbalances in mean, SD t-MoCA were observed between participants assigned to colchicine (13.1, 5.5) and placebo (15.9, 4.2). Mean t-MoCA at 6 months was similar between participants assigned to colchicine (16.5, 4.5; n=36) and placebo (17.0, 3.8; n=31), with a mean difference 0.6 (95% CI -1.8, 3.0, p=0.6). The mean improvement in t-MoCA from baseline to 6 months was greater with colchicine (3.20, 4.0) compared with placebo (1.2, 4.8; mean difference 2.1, 95%CI -0.8, 4.9, p=0.15), and similar trends were observed between baseline and end-of-study (mean difference 1.9, 95% -0.5, 4.2, p=0.11).

Disclosure of interest: Colin P. Derdeyn: Consultancy to Penumbra Inc, NoNO Inc, and Euphrates Vascular Inc. Yan Ma: nothing to disclose. Tao Wang: nothing to disclose. Wei Ni: nothing to disclose. Haibo Wang: nothing to disclose. Delin Liu : nothing to disclose. Xinyi Sun: nothing to disclose. Yuxiang Gu: nothing to disclose. Guoguang Zhao: nothing to disclose. Liqun Jiao: nothing to disclose.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.07 - IMAGING - Non acute

P482 - ESOC2025-LB-119

APICES: ADVANCING STROKE CARE THROUGH DEEP LEARNING PREDICTION OF MALIGNANT INFARCT SWELLING

Johannes Tünnerhoff^1,2, Khouloud Poli^1,2, Susanne Diekmann³, Felix Thielke³, Joshua Mbroh^1,2, Davide Carone⁴, Alistair Perry⁴, George Harston⁴, Benjamin Geisler³, Hannah Strohm³, Benjamin Bender⁵, Ulrike Ernemann⁵, Dominik Lehrieder⁶, Hermann Neugebauer⁶, Enayatullah Baki⁷, Silke Wunderlich⁷, Jan Purrucker⁸, Helge Kniep⁹, Johanna Ernst¹⁰, Sebastian Stösser¹¹, Jens Minnerup^12,13, Ludwig Schlemm¹⁴, Johann Pelz¹⁵, Marek Sykora^16,17, Robert Forbrig¹⁸, Michael Gliem¹⁹, Katharina Althaus^20,21, Felix Schlachetzki²², Markus Wenzel^3,23, Sven Poli^1,2

¹Hertie Institute for Clinical Brain Research, University Hospital Tübingen and University of Tübingen, Tübingen, Germany, ²Department of Neurology, University of Tübingen, Tübingen, Germany, ³Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany, ⁴Brainomix, Oxford, United Kingdom, ⁵Department of Neuroradiology, University of Tübingen, Tübingen, Germany, ⁶Department of Neurology, University Hospital Würzburg, Würzburg, Germany, ⁷Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany, ⁸Department of Neurology, University of Heidelberg, Heidelberg, Germany, ⁹Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, ¹⁰Department of Neurology, Hannover Medical School, Hannover, Germany, ¹¹Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany, ¹²Department of Neurology, University of Münster, Münster, Germany, ¹³Department of Neurology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany, ¹⁴Department of Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, ¹⁵Department of Neurology, University of Leipzig, Leipzig, Germany, ¹⁶Department of Neurology, St. John's Hospital, Vienna, Austria, ¹⁷Medical Faculty, Sigmund Freud University, Vienna, Austria, ¹⁸Department of Neuroradiology, Ludwig Maximilian University (LMU), Munich, Germany, ¹⁹Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany, ²⁰Department of Neurology, University Hospital Ulm, Ulm, Germany, ²¹Kliniken Christophsbad Göppingen, Göppingen, Germany, ²²Department of Neurology, University Hospital Regensburg, Regensburg, Germany, ²³Constructor University, Bremen, Germany

Background: Malignant swelling of large hemispheric infarcts (LHI) occurs in up to 50% of cases, often causing life-threatening herniation. Decompressive hemicraniectomy within 48 hours is recommended, but swelling dynamics vary, making optimal timing unclear. Routine ultra-early decompression may harm patients without swelling. Current neuroimaging, clinical, and blood-based biomarkers lack robustness for edema prediction. This study applies deep learning to predict malignant infarct swelling and its timing.

Case Report / Trial: This multicenter study includes 17 stroke centers and retrospective clinical/imaging datasets from 1,687 LHI patients. AI core lab software (Brainomix, Oxford, UK) analyzed sequential CT scans. Baseline biomarkers include eASPECTS, frailty index, infarct volume, collateral score, clot permeability, and hypoperfusion extent. A convolutional neural network (CNN) segments infarcted volumes and quantifies edema via imaging registration. The study, conducted with Fraunhofer MEVIS and Brainomix, was funded by the German Innovation Fund (NCT04057690).

High impact reason: APICES is the largest deep learning study on malignant infarct swelling, advancing the understanding and management of LHI.

Results: Based on 1,457 patients, 587 (40.3%) underwent DHC. They were younger (median 58 vs. 77 years, p<0.001), more often male (61% vs. 47%, p<0.001), had larger infarcts (87 vs. 64 ml, p<0.001), lower brain frailty index (2.95 vs. 4.85, p<0.001), less frequent thrombectomy (48% vs. 58%, p<0.001), and greater midline shift (1.1 vs. 0.8 cm, p=0.004). A random forest model using clinical data and imaging-derived parameters achieved 73% accuracy (F1-score 0.72, AUROC 0.79), outperforming a combined clinical random forest and CNN-based approach.

Disclosure of interest: Sven Poli served as the Principal Investigator (PI) of the multi-center APICES project, funded with EUR 1.2 million by the German Federal Joint Committee Innovation Fund, with imaging analysis contributed free of charge by Brainomix, Oxford, UK.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.05 - NEUROINTERVENTION

P483 - ESOC2025-LB-143

FIRSTLINE ASPIRATION THROMBECTOMY WITH RED43 REPERFUSION CATHETERS IN ACUTE ISCHEMIC STROKE DUE TO MEDIUM OR DISTAL VESSEL OCCLUSIONS

Vera Aebischer¹, Aikaterini Anastasiou¹, Alex Brehm¹, Nikolaos Ntoulias¹, Nikki Rommers², Marios Psychogios¹, on Behalf of the Red43,Collaborators¹

¹Department of Neuroradiology, University Hospital Basel and University of Basel, Basel, Switzerland, ²Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland

Background: Techniques for endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to medium or distal vessel occlusions (MDVO) need to be improved. RED43 Reperfusion Catheters (RED43) represent a novel device paving ground for innovative techniques.

Case Report / Trial: The objective of this study was to describe first-pass reperfusion rates with a triaxial direct aspiration first-pass technique (ADAPT) and a novel, quadriaxial technique (QUATTRO-ADAPT) using RED43s. Data were collected from 11 stroke centres across the US, Canada and Europe between 2023 and 2025 and included patients with AIS due to primary, isolated MDVOs. Primary outcome was first-pass successful reperfusion rate (mTICI ⩾2b). Additionally, complications and functional outcomes up to 90 days were evaluated. The study was not funded.

High impact reason: ADAPT is emerging as a promising technique for EVT in MDVOs. However, data on novel techniques with new aspiration devices, such as the RED43, remain scarce.

Results: We collected 85 cases. Mean age was 72.7 (± 12.4) years and median NIHSS score 9 (IQR 6-15). 69.4% had an occlusion of the co- or nondominant M2, 11.8% of the M3, 8.2% of the P2, 3.5% of the A3, and 2.4% of the A2, P1 and SUCA, respectively. Successful first-pass reperfusion was 63.5% overall, with 55.6% for the triaxial ADAPT and 69.4% for the quadriaxial QUATTRO-ADAPT. Complications included subarachnoid hemorrhage (3.5%), parenchymal hematoma type 2 (2.4%), and symptomatic intracerebral hemorrhage (1.2%). Functional independence (mRS 0-2) at 90 days was observed in 58.7%. This study shows that ADAPT, especially in a quadriaxial approach, is effective and safe.

Disclosure of interest: MP: Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783), ICARUS (32003B_220118) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Grants for the DISTAL trial from Stryker Neurovascular Inc., Medtronic Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc., Sponsor-PI SPINNERS trial (Funded by a Siemens Healthineers AG Grant), Research agreement with Siemens Healthineers AG, Local PI for the ASSIST, EXCELLENT, TENSION, COATING, SURF and ESCAPE-NEXT trials. Speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. VA, AA, AB, NN and NR: nothing to disclose

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.03 - PROGNOSIS AND OUTCOME AFTER STROKE

P484 - ESOC2025-LB-158

12 MONTH OUTCOMES AFTER CEREBRAL VENOUS THROMBOSIS: RESULTS OF THE DOAC-CVT STUDY

Jelle Vellema¹, Anita van de Munckhof¹, Sebastiaan De Bruijn², Adriana Conforto³, Teddy Wu⁴, Ana Gomes⁵, Nesrin Ergin⁶, Diana Aguiar de Sousa⁷, Katarina Jood⁸, Jukka Putaala⁹, Turgut Tatlisumak⁸, Jose Férro¹⁰, Jonathan Coutinho¹

¹Amsterdam UMC, Amsterdam, Netherlands, ²Haga Ziekenhuis, Den Haag, Netherlands, ³Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ⁴Christchurch Hospital, Christchurch, New Zealand, ⁵Centro Hospitalar Tondela Viseu, Viseu, Portugal, ⁶PAÜ Tıp Fakültesi Nöroloji, Denizli, Türkiye, ⁷Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal, ⁸Sahlgrenska University Hospital, Gothenburg, Sweden, ⁹Helsinki University Central Hospital, Helsinki, Finland, ¹⁰Centro de Estudos Egas Moniz, Lisbon, Portugal

Background: DOAC-CVT showed similar 6-month effectiveness and safety of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) for treatment of cerebral venous thrombosis (CVT). In this study, we report the 12-month outcomes.

Case Report / Trial: DOAC-CVT was an international, prospective, observational cohort study. Adults with CVT who started oral anticoagulants within 30 days were eligible. Oral anticoagulant type was at the discretion of treating physicians. The primary endpoint was a composite of recurrent symptomatic thrombotic events and major bleeding. Secondary endpoints were mRS scores and mortality rates. Deaths and thrombotic and bleeding events were adjudicated by an independent committee. Propensity score inverse probability weighting was used.

High impact reason:

Results: From Jan-2021 to Jan-2024, 619 patients from 23 countries were enrolled. 401(65%) were started on a DOAC and 218(35%) on VKA. There were no differences in age (median 42vs40 years, p=0.14) or proportion of women (63%vs64%, p=0.77). Twelve-month data were available for 522(84%) patients. In total, 14(3.5%) patients in the DOAC group and 8(3.7%) patients in the VKA group had a primary outcome event (wOR 1.05; 95%CI[0.35-2.64]). Three primary events occurred between 6-12 months. Mortality (1.5%vs2.3%; wOR 0.76[0.23-2.68]) and mRS 3-6 (5.2%vs6.0%; wOR 0.82[0.37-1.80]) were also similar between groups. 240(46%) patients had ongoing anticoagulation at 12 months. Median treatment duration for patients who stopped treatment was 200 days(IQR:186-279) for the DOAC group and 207 days(IQR:140-320) for the VKA group.

Conclusion: Both DOAC and VKAs were effective and safe in the prevention of recurrent venous thrombotic events, with no difference between the two treatment options.

Disclosure of interest: HJA declares having received speaker honoraria and personal fees for an advisory board or data monitoring board memberships from Boehringer Ingelheim, Roche and Novo Nordisk, Bayer, Pfizer, BMS, Novartis, and AstraZeneca. JRB recieved a travelling grant from Neuraxpharm. All other authors report having no conflicts of interest.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P485 - ESOC2025-LB-160

EARLY VERSUS DELAYED ANTICOAGULATION IN ACUTE ISCHAEMIC STROKE ACCORDING TO RADIOLOGICAL MARKERS OF CEREBRAL SMALL VESSEL DISEASE: SUBGROUP ANALYSES OF THE OPTIMAS RANDOMISED CONTROL TRIAL

James Lyon¹, Philip Nash¹, Jonathan Best¹, Thanyalak Amornpojnimman¹, James Ruffle², Chris Foulon², Hakim-Moulay Dehbi³, Norin Ahmed³, Sue Massingham¹, Amalia Ndoutoumou³, Tishok Vanniyasingam³, Nicholas Freemantle³, Parashkev Nachev², David Doig^1,4, David Werring¹

¹Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, United Kingdom, ²Institute of Neurology, University College London, London, United Kingdom, ³Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom, ⁴Department of Neuroradiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom

Background: Following acute ischaemic stroke, it is uncertain whether neuroimaging markers of cerebral small vessel disease (SVD) modify the effects of the timing of direct oral anticoagulant (DOAC) initiation.

Case Report / Trial: OPTIMAS was a randomised, parallel-group, open-label trial with blinded outcome assessment. Participants were randomised to early (⩽4 days) or delayed (days 7-14) DOAC initiation. The primary outcome was a composite of recurrent ischaemic stroke, symptomatic intracerebral haemorrhage and systemic arterial embolism. Sites sent anonymised CT or MRI neuroimaging studies for central assessment by trained observers masked to treatment allocation. On MRI scans we rated the number and location of cerebral microbleeds (CMBs), white matter hyperintensities (WMH), lacunes, and enlarged perivascular spaces, allowing us to calculate a total SVD burden score (rated 0-4). On CT scans we rated leukoaraiosis, atrophy and lacunes.

High impact reason: We found no evidence for heterogeneity in the effects of early DOAC treatment according to radiological markers of cerebral small vessel disease on MRI.

Results: At the time of writing data are available for the 1093 participants (mean age 76.6[SD 10.1], 42.1% female) with MRI. Figure 1 shows primary outcome events occurring in patients allocated to early and delayed DOAC according to the frequency of CMBs, severe WMH, lacunes, enlarged basal ganglia perivascular spaces and SVD burden score. The effects of DOAC timing on the primary outcome did not differ according to any of the markers including CMBs (p interaction=0.522) and overall SVD burden score (p interaction=0.630). CT neuroimaging analyses will be presented at the conference.

Disclosure of interest: James Lyon: Nothing to disclose, Philip S. Nash: Nothing to disclose, Jonathan G. Best: Nothing to disclose, James K. Ruffle: Nothing to disclose, Thanyalak Amornpojnimman: Nothing to disclose, Chris Foulon: Nothing to disclose, Hakim-Moulay Dehbi: Nothing to disclose, Norin Ahmed: Nothing to disclose, Sue Massingham: Nothing to disclose, Amalia Ndoutoumou: Nothing to disclose, Tishok Vanniyasingam: Nothing to disclose, Prof Nick Freemantle: Nothing to disclose, Prof Parashkev Nachev: Nothing to disclose, David Doig: Nothing to disclose Prof David J. Werring PhD: Nothing to disclose. The OPTIMAS trial was funded by the British Heart Foundation

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P486 - ESOC2025-LB-167

MULTI-CENTER RANDOMIZED PHASE II CLINICAL TRIAL ON REMOTE ISCHEMIC CONDITIONING IN ACUTE ISCHEMIC STROKE WITHIN 9 HOURS OF ONSET IN PATIENTS INELIGIBLE TO RECANALIZATION THERAPIES

Susanna Diamanti, Mauro Tettamanti¹, Francesco Pedrazzini², Matteo Farè², Raffaele Ornello³, Enrico Colangeli³, Cindy Tiseo³, Chiara Bazzini², Massimo Cartabia¹, Anna Cavallini⁴, Giuliano Sette⁵, Simona Sacco³, Carlo Ferrarese^2,6, Simone Beretta²

¹Dipartimento di Ricerca Neuroscienze, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy, ²Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy, ³Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L'Aquila, Italy, ⁴UOC Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy, ⁵NEuroscienze Salute Mentale e Organi di Senso (NESMOS) Department, Faculty of Medicine and Psychology, Sant’Andrea Hospital, Sapienza University of Rome, Roma, Italy, ⁶Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy

Background: Preclinical and clinical research suggests remote ischemic conditioning (RIC) may have neuroprotective effects,though evidence in non-recanalizable stroke patients is insufficient.

Case Report / Trial: A phase II, multicenter, randomized trial was conducted. Patients with NIHSS score from 5 to 25, ineligible to recanalization therapies and enrolled within 9 hours of onset were assigned to either RIC+standard medical therapy or standard medical therapy alone. RIC involved four alternating cycles of arm ischemia using a blood pressure cuff. The primary outcome was percentage change in the National Institute of Health Stroke Scale (NIHSS) score at 72 hours. Secondary outcomes included percentage change in NIHSS scores at 24 and 48 hours, modified Rankin Scale (mRS) score at 90 days, and feasibility (ClinicalTrials.gov number:NCT04400981).

High impact reason: We demonstrated that in stroke patients ineligible for recanalization therapies, RIC’s application within 9 hours of stroke onset adds no clinical benefit.

Results: From August 2021 to March 2024, 80 patients (40 in each group) were enrolled at four centers. The median NIHSS percentage change at 72 hours was 23.6 in the RIC group and 29.9 in the control group(AdjCoefficient -3.8; 95%CI, -19.7 to 12.1;p=0.634). The median NIHSS percentage change was 0.0 in the RIC group vs 0.0 in the control group(AdjCoefficient -7.1;95%CI, -19.7 to 5.6;p=0.267) at 24 hours, and 18.3 in the RIC group vs 20.5 in the control group(AdjCoefficient -3.9; 95%CI, -19.2 to 11.4,p=0.612) at 48 hours. The median mRS score at 90 days was 3 in both groups(p=0.884). 97.5% of patients randomized to the RIC group completed RIC in full.

Disclosure of interest: nothing to disclose.

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.01 - REHABILITATION

P487 - ESOC2025-LB-174

THE COMBINATION OF INOSINE, NICOTINAMIDE, RIBOFLAVIN AND SUCCINIC ACID IN THE COMPLEX REHABILITATION OF STROKE SURVIVORS: A MULTICENTER DOUBLE-BLIND PLACEBO-CONTROLLED RANDOMIZED STUDY

Tatiana Kharitonova¹, Alexey Shmonin¹, Diana Tokareva², Igor Vozniuk¹

¹Pavlov First Saint Petersburg State Medical University, Saint-Petersburg, Russian Federation, ²Saint Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation

Background: The combination of inosine, nicotinamide, riboflavin and succinic acid is used in several countries in acute stroke to improve outcome due to presumed antihypoxic and antioxidant effects. We hypothesize that this combination may enhance rehabilitation process in stroke survivors.

Case Report / Trial: NCT05935787.

Patients 40-80 y.o. with previous (within 14-90 days) carotid ischemic stroke or hemispheric hemorrhagic stroke, scored 3-4 by modified Rankin scale (MRS), were randomized into experimental group to receive experimental medication or placebo (20 ml intravenously for 15 days, followed by oral intake for 25 days). Standard inpatient rehabilitation was provided for the first 15 days and continued in the outpatient setting (10 visits, 2-3 times per week) for the next 25 days. The primary endpoint was the change in the Performance score of the Canadian Occupational Performance Measure (COPM) after the end of the treatment course compared to baseline. MRS score was assessed on day 180 poststroke via the structured telephone interview.

High impact reason: in a randomized double-blind placebo-controlled study we demonstrate improvement of stroke rehabilitation outcomes.

Results: We enrolled 240 subjects (March 2023 - June 2024), 221 (93%) had ischemic stroke, 176 (74%) were 14-45 days post stroke, median age 66 (IQR 54-78), males 129 (54%). In the experimental group (n=121), the average change of COPM performance score was 3.41 vs. 2.55 in the placebo group (n=117) (p<0.001; 96% CI for the difference exceeded the prespecified superiority margin). MRS 0-2 was achieved by 89 (74%) in the experimental and by 65 (56%) in the placebo group (p=0.0065).

Disclosure of interest: None.

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 05.02 - SECONDARY PREVENTION

P488 - ESOC2025-LB-190

EECP therapy improves cerebral vasodilatory reserve in symptomatic severe intracranial steno-occlusive disease: a randomized-controlled clinical trial

May Zin Myint^1,2, Arvind Sinha¹, Benjamin Tan¹, Anil Gopinathan¹, Leonard Yeo¹, Lily Yh Wong¹, Bernard Pl Chan¹, Hock Luen Teoh¹, Raymond Cs Seet¹, Mingxue Jing¹, Lian Shen³, Anne Alexandrov⁴, Andrei V Alexandrov⁵, Georgios Tsivgoulis⁶, Vijay K Sharma¹

¹National University Hospital (NUH), Singapore, Singapore, ²Ng Teng Fong General Hospital, Singapore, Singapore, ³Department of Biostatistics, National University Singapore, Singapore, Singapore, ⁴University of Tennessee Health Science Center at Memphis,College of Graduate Health Sciences, Memphis, Tennessee, United States, ⁵University of Arizona at Phoenix, Department of Neurology and Banner University Medical Center, Phoenix, Arizona, United States, ⁶Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

Background: Patients with intracranial atherosclerosis(ICAS) have high rates of stroke recurrence despite best medical therapy(BMT), and routine intracranial stenting is not recommended. Cerebral ischemic events are much higher patients with severe ICAS and impaired cerebral vasodilatory reserve(CVR). We investigated the efficacy of adjunctive Enhanced External Counter-Pulsation(EECP, Vasomedical, Inc) therapy in patients with symptomatic severe ICAS involving intracranial internal carotid(ICA) and/or middle cerebral artery(MCA).

Case Report / Trial: This single-centre prospective, randomized-controlled, open-label, blinded end-point trial, enrolled patients experiencing acute cerebral ischemia within past 3-months due to severe ICAS and impaired CVR (on transcranial Doppler(TCD) and acetazolamide-challenged HMPAO-SPECT). Participants were randomized(1:1) to BMT alone or BMT combined with adjunct EECP therapy administered in a standardised protocol. The primary endpoint was improvement in CVR at 6-months, with reduction in stroke recurrence within 1-year as the secondary endpoint(ClinicalTrials.gov:NCT03921827).

High impact reason: This trial provides the first evidence that adjunct EECP therapy significantly improves cerebral hemodynamic parameters and reduces stroke recurrence in patients with symptomatic and severe ICAS.

Results: From January 2019 to July 2023, 122 eligible patients were randomised. Baseline characteristics were similar between groups, with median age 58-years (range 43-64) and 61% men. Compared to BMT group, EECP patients showed significantly greater median CVR improvement from baseline SPECT at 6-months (6.2%, IQR 4-8) compared to BMT group (0.6%, -1.0-2.0;p<0.001). Median TCD breath holding index was also significantly higher in the EECP group [0.74 (0.52-1.04) versus BMT [0.23 (0-0.45),p<0.001]. EECP therapy led to four-fold decrease in recurrent stroke at 1-year [4 (6.5%) versus 16 (26.2%) in BMT group, p=0.006].

Disclosure of interest: Dr. Tanaka has no conflicts of interest to disclose.; Dr. Pensato has no conflicts of interest to disclose.; Dr. AlShamrani has no conflicts of interest to disclose.; Dr. Katsanos has no conflicts of interest to disclose.; Dr. Balali has no conflicts of interest to disclose.; Dr. Ray has no conflicts of interest to disclose.; Dr. Kasner has no conflicts of interest to disclose.; Dr. Beyer-Westendorf has received personal honoraria (lectures, advisory boards) and travel support from Bayer, Daiichi Sankyo, Janssen, Sanofi, and Portola/Alexion; and has received institutional research support from Bayer, Daiichi Sankyo, Janssen, LEO, Pfizer, and Portola/Alexion.; Dr. Toni has no conflicts of interest to disclose.; Dr. Xu has no conflicts of interest to disclose.; Dr. Knutsson is an employee of AstraZeneca; Dr. Ladenvall is an employee of AstraZeneca.; Dr. Sharma has received research grants/contracts from Bayer and Bristol-Myers Squibb and has served as a consultant for Bayer.; Dr. Shoamanesh has received research grants/contracts from AstraZeneca, Bayer, the Canadian Institutes of Health Research, Daiichi Sankyo Company, the Heart and Stroke Foundation of Canada, the National Institutes of Health, Octapharma USA, Inc., and Servier Affaires Medicales; has served on advisory boards for AstraZeneca, Bayer, Daiichi Sankyo Company, and Takeda Pharmaceutical Company; and has served on a data and safety monitoring board for Bayer.; Dr. Demchuk has received honoraria for lectures from AstraZeneca Canada and Novo Nordisk AS; has participated on advisory boards for Hoffmann-La Roche Limited and NovaSignal; has served on data and safety monitoring committees for Lumosa and Philips; holds stock and a patent (Patent number: 10373718; 2023039659; 20230277151) for Circle NVI.

04.00 - DIAGNOSIS / ETIOLOGY - 04.01 - DIAGNOSIS/INVESTIGATION OF STROKE ETIOLOGY

P489 - ESOC2025-LB-477

AETIOLOGY AND CLASSIFCATION OF ISCHAEMIC STROKE WITH POSITRON EMISSION TOMOGRAPHY THROMBUS IMAGING

Beth Whittington¹, Craig Balmforth¹, Neil Craig¹, Audrey White¹, Piotr Slomka², Norman Koglin³, Andrew Stephens³, Iris Hardewig³, Edwin van Beek¹, Marc Dweck¹, Michelle Williams¹, Joanna Wardlaw¹, David Newby¹, William Whiteley¹

¹British Heart Foundation Centre Research of Excellence University of Edinburgh, Edinburgh, United Kingdom, ²Cedars-Sinai Medical Centre, Los Angeles, United States, ³Life Molecular Imaging GmbH, Berlin, Germany

Background: The origin of thrombus in ischaemic stroke is often unclear. Fluorine-18 GP1 ([¹⁸F]GP1) radiotracer is specific for the activated glycoprotein IIb/IIIa receptor expressed on platelets and has potential as a thrombus tracer. We performed PET imaging with [¹⁸F]GP1 in a cohort of people with stroke.

Case Report / Trial: Patients with ischaemic stroke had ambulatory electrocardiogram, bubble-contrast echocardiography and [¹⁸F]GP1 positron emission tomography and PET/CT angiography <21 days of symptom onset. An expert stroke panel classified stroke with the Causative Classification System (CCS) with and without [¹⁸F]GP1 PET/CT results.

High impact reason: Hybrid [¹⁸F]GP1 PET/CT imaging in patients with ischaemic stroke identified the thrombus across stroke subgroups and reclassified cause in a quarter of cases. This technique has potential to identify stroke cause in clinical practice.

Results: Seventy patients (28 undetermined, 24 cardioembolic, 9 small artery occlusion, 7 large artery atherosclerosis and two other uncommon causes using CCS) participated. Forty-four had at least one source of [¹⁸F]GP1uptake: 22 carotid, 7 vertebral, 4 aorta, 3 left atrium, 2 left ventricle, 2 lower limb deep veins, 8 native valves (4 aortic and 4 mitral) and two prosthetic valves. [¹⁸F]GP1 uptake reclassified stroke aetiology in 19 (27%) patients. In 3/9 patients classified as small artery occlusion, [¹⁸F]GP1 uptake identified large artery atherosclerosis or cardio-embolic causes (Figure 1). Native valvular [¹⁸F]GP1 uptake occurred on thickened or calcified valves (Figure 2). Only 3/6 patients with atrial fibrillation and presumed cardioembolism had [¹⁸F]GP1 uptake in the atrial appendage. There were two cases of embolism from deep vein thrombosis through a patent foramen ovale (Figure 3).

Disclosure of interest: Funded by the Canadian Institutes of Health Research and the Population Health Research Institute.

09.00 - PRE-HOSPITAL SERVICE ORGANISATION - 09.01 - PRE-HOSPITAL SERVICE ORGANISATION

P490 - ESOC2025-LB-582

Clinical Outcomes of a Personalized EMS Destination Selection Algorithm for Prehospital Stroke Triage in the United States: The MAP-STROKE In Silico Trial

Grant Brown¹, Nicholas Mohr², Jacob Seedorff¹, Ferney Henao-Ceballos¹, Anne Zepeski², Marc Ribo³, Jeffrey Saver⁴, Natalia Pérez de la Ossa⁵, Santiago Ortega-Gutierrez⁶

¹University of Iowa College of Public Health, Department of Biostatistics, Iowa City, United States, ²Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States, ³Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Spain, ⁴Comprehensive Stroke Center and Department of Neurology David Geffen School of Medicine at UCLA, Los Angeles, United States, ⁵Stroke Unit, Department of Neuroscience (A.R., N.P.O.), University Hospital Germans Trias I Pujol, Badalona, Spain, ⁶Department of Neurology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States

Background:Optimal stroke triage remains a challenge, as current guideline-based strategies fail to account for individual patient characteristics. We developed MAP-STROKE, a Bayesian triage algorithm, and evaluated compared to AHA guideline-adherent routing in the US in-silico.

This population-based simulation used patient-level data from Virtual International Stroke Trials Archive, RACECAT, and FAST-MAG trials. MAP-STROKE used Bayesian models integrating diagnostic uncertainty, patient data, and time-dependent treatment effects, optimizing 3-month modified Rankin Scale (mRS) outcomes. We simulated >115 million stroke events over a 10-year-equivalent U.S. population, comparing triage outcomes from MAP-STROKE to AHA guideline-based routing.

Case Report / Trial:MAP-STROKE Trial (in-silico)

High impact reason: A Bayesian, patient-level EMS triage model offers an effective alternative to guideline-based routing. Optimizing treatment access across all stroke subtypes, MAP-STROKE could improve stroke outcomes at scale, particularly in rural regions. This approach is general, applicable to stroke triage systems worldwide.

Results: MAP-STROKE outperformed guideline-based triage, improving functional outcomes at 3 months: net benefit of >55k patients/10yr with mRS ⩽2. For LVO patients, MAP-STROKE reduced time-to-EVT by 2.79 hours (95% Cr-I: 2.74–2.84) in rural regions, increasing the proportion achieving mRS ⩽2 by 5.0% (95% Cr-I: 4.9%–5.1%), with smaller gains in suburban (3.6%) and urban (2.4%) settings. However, non-LVO and hemorrhagic stroke patients experienced transport delays (+0.37 hr and +0.36 hr, respectively), reducing tPA administration by 4.0% (95% Cr-I: 3.9%–4.1%) and showing a slight 0.2% decrease in mRS ⩽2.

Disclosure of interest: Nothing to Disclose

02.00 - INTRACRANIAL HEMORRHAGE - 02.01 - INTRACEREBRAL HAEMORRHAGE

P491 - ESOC2025-LB-552

PREHOSPITAL IDENTIFICATION OF SEVERE INTRACRANIAL HEMORRHAGE BY MEASURING THE GFAP RELEASE RATE

Olli Mattila¹, Saana Pihlasviita¹, Tiina Nukarinen¹, Markku Kuisma², Heini Harve-Rytsälä², Juhani Ritvonen¹, Gerli Sibolt¹, Sami Curtze¹, Daniel Strbian¹, Mikko Pystynen², Turgut Tatlisumak^3,4, Perttu J. Lindsberg¹

¹Neurology and Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, ²Emergency Medicine and Services, Department of Emergency Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, ³Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden, ⁴Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden

Background: Patients with rapidly enlarging intracranial hemorrhage (ICrH) are prime candidates for early therapeutic interventions, including blood pressure control, reversal of anticoagulation, and early minimally invasive surgery. Rapidly increasing plasma levels of glial fibrillary acidic protein (GFAP) may be a biomarker for prehospital identification of these patients.

Case Report / Trial: Using Alphalisa®, we measured the prehospital GFAP release rate (pg/mL/min) from two consecutive plasma samples with a median (IQR) last-known-well to sampling time of 60 (39-110) and 98 (73-146) minutes, collected in the prehospital setting and upon hospital arrival. We included 795 patients aged >55 years transported to our tertiary stroke center as recanalization candidates.

High impact reason: A high GFAP release rate accurately identifies a subgroup of ICrH patients with rapid and severe bleeding. Dual-timepoint point-of-care GFAP measurement could be used for prehospital identification and recruitment of these patients into future therapeutic studies.

Results: A GFAP release rate cut-off of >75 pg/mL/min identified a group of 30 ICrH patients, without false positives (PPV 100%). This group contained 28.0% of all ICrH patients and 3.8% of all transported stroke code patients. Of the identified patients one patient had subdural and subarachnoid bleeding, and the rest intracerebral hemorrhage with or without other bleeding (IVH, SAH, SDH). The median (IQR) admission ICH volume was 43.4 (20.9-54.8) mL, the admission NIHSS was 16 (12-21), and the early bleeding rate (defined as ICH volume / LKW to computed tomography (CT) time) was 22.0 (10.0-29.0) mL/h.

Disclosure of interest: Nothing to disclose

Poster Session II - LATE BREAKING ABSTRACTS

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.03 - PROGNOSIS AND OUTCOME AFTER STROKE

P1090 - ESOC2025-LB-139

CONTRAST-ASSOCIATED NEPHROPATHY RISK EVALUATION IN ACUTE ISCHEMIC STROKE AFTER ENDOVASCULAR THROMBECTOMY - CAN-REST STUDY

Ghil Schwarz¹

¹Department of Neurology and Stroke Unit - ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy, Milan, Italy

Background: Contrast-associated acute kidney injury (CA-AKI) is an understudied complication of endovascular thrombectomy (EVT) in acute ischemic stroke (AIS). We assessed its incidence, risk factors, impact, and developed/validated a predictive score.

Case Report / Trial: International study (74 centers, NCT06596603) on EVT-treated AIS in 2023. CA-AKI was defined per AKIN and/or KDIGO criteria. Associations between variables, CA-AKI, and outcomes were analyzed using multivariate models, adjusting for factors with p<0.1 in univariate analysis. Stepwise regression identified risk score variables (70% derivation, 30% validation).

High impact reason: CA-AKI is a potentially significant complication affecting outcomes. The risk score may help identify high-risk patients early, enabling preventive strategies and interventions.

Results: 7109 patients met inclusion criteria: CA-AKI occurred in 542 (7.6%). Independent predictors: male sex (aOR1.32[1.08-1.61]p=0.006) pre-AIS mRS (1.47[1.11-1.94]p=0.007), chronic kidney disease (1.30[1.06-1.60]p=0.012), heart failure (1.44[1.14-1.82]p=0.002), hemoglobin (0.90[0.86-0.95]p<0.001), blood glucose (1.00[1.00-1.01]p=0.001), glomerular filtration rate (0.99[0.98-0.99]p<0.001), tandem occlusion (1.37[1.07-1.75]p=0.0149), 24h-NIHSS (1.04[1.02-1.05])p<0.001), other potential AKI causes (3.76[3.11-4.56]p<0.001) and symptomatic hemorrhagic transformation (1.37[1.02-1.84]p=0.033). CA-AKI was linked to worse 90-day mRS (aOR1.88[1.57-2.26]p<0.001), mRS>2 (1.37[1.03-1.82]p=0.031), and death (2.71[2.14-3.42]p<0.001). Model 1 (pre-EVT variables) showed fair discrimination (AUROC 0.71 [0.68–0.74] derivation; 0.73 [0.68–0.78] validation). Model 2, adding EVT-related and early post-EVT variables, performed better (AUROC 0.78 [0.75–0.81] derivation; 0.81 [0.76–0.86] validation).

Disclosure of interest: There are no conflicts of interest. NK and AS are employees of Life Molecular Imaging who provided reagents for 18F-GP1 production. Beth Whittington is supported by the British Heart Foundation( FS/CRTF/21/24129). Michelle Williams is supported by the British Heart Foundation (FS/ICRF/20/26002, FS/11/014, CH/09/002), RG/16/10/32375, RE/18/5/34216). Marc Dweck is supported by the British Heart Foundation (FS/14/78/31020) and by the Sir Jules Thorn Biomedical Research Award 2015 (15/JTA). David Newby is supported by the British Heart Foundation (CH/09/002, RG/16/10/32375, RE/18/5/34216). Neil Craig is supported by the Medical Research Council (MR/Y009932/1). Craig Balmforth is supported by the Medical Research Council (MR/Y009770/1). Edwin van Beek is supported by the Scottish Imaging Network: A Platform of Scientific Excellence ( SINAPSE. Piotr Slomka are supported by NIH NHLBI grant 5R01HL135557. Will Whiteley is supported by the Chief Scientist’s Office, Alzheimer’s Society. Joanna Wardlaw is supported by the UK Dementia Research Institute which receives its funding from DRI Ltd, funded by the UK Medical Research Council, Alzheimer’s Society and Alzheimer’s Research UK.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P1091 - ESOC2025-LB-203

EXTRACRANIAL-INTRACRANIAL BYPASS SURGERY FOR SYMPTOMATIC CEREBRAL ARTERY OCCLUSION (CMOSS): FINAL RESULTS OF A RANDOMIZED TRIAL

Yan MA¹, Tao Wang¹, Wei Ni², Haibo Wang³, Delin Liu¹, Xinyi Sun¹, Colin Derdeyn⁴, Yuxiang Gu², Guoguang Zhao¹, Liqun Jiao⁵

¹Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China, ²Department of Neurosurgery, Huashan Hospital, Fudan University, National Center for Neurological Disorders, Shanghai, China, ³Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China, ⁴Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Virginia, United States, ⁵Department of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China

Background: In the initial results for Carotid or Middle cerebral artery Occlusion Surgery Study(CMOSS), we found no significant difference between the bypass surgery group and the medical group regarding stroke or death within two years. The present study aimed to determine whether a benefit exists over a longer time window.

Case Report / Trial: This study is a long-term follow-up of a multi-center randomized trial. Symptomatic patients with hemodynamically compromised internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion were randomized to bypass surgery plus medical treatment or medical treatment alone. We extended follow-up to up to ten years. The primary outcome remained a composite of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days after randomization.

High impact reason:In this final results with follow-up for a median of 7.6 years, the risk of recurrent stroke was significantly lower in the bypass surgery group. The findings supported EC-IC bypass surgery with rigorous perioperative management as the first-line therapy for long-term stroke prevention in selected patients with symptomatic ICA or MCA occlusion.

Results: 324 patients were assigned to surgical (n=161) or medical group (n=163); the median duration of follow-up was 7.6 years ([IQR], 2.3 to 9.2). The primary outcome occurred in 18 of 161 patients (11.2%) in the surgical group, significantly lower than that in the medical group (32 of 163 patients [19.6%]; RR, 0.57; 95% CI, 0.33 to 0.97; P=0.04). The all-cause mortality was 8.1% in surgical group vs. 8.6% in medical group (RR, 0.94; 95% CI, 0.46 to 1.94]; P=0.93).

Disclosure of interest: All authors: nothing to disclose

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.01 - REHABILITATION

P1092 - ESOC2025-LB-219

THE IMPACT OF LEVODOPA ON POST-STROKE FATIGUE DURING IN-HOSPITAL REHABILITATION

Lukas Boos¹, Josefin E. Kaufmann¹, Stefan Engelter², Christopher Tränka²

¹Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland, ²Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland

Background: Post-Stroke Fatigue (PSF) occurs frequently after acute stroke and negatively affects rehabilitation. This study investigated whether levodopa, compared to placebo, impacts PSF during in-hospital rehabilitation.

Case Report / Trial: ESTREL-Fatigue utilized data from the multicenter, randomized, double-blind, placebo-controlled ESTREL (Enhancement of Stroke REhabilitation with Levodopa) trial. Participants with an acute stroke were randomly assigned to receive either levodopa/carbidopa (100/25mg) or placebo three times daily for 39 days. All ESTREL-participants with (i) information about the presence of fatigue at 5 weeks after randomization and (ii) who took at least 80% of the study medication were eligible for this study. Fatigue was defined as a T-score of ⩾55 in the PROMIS Fatigue Short Form-4a after 5 weeks. Logistic regression was used to evaluate the odds of fatigue in both treatment groups. Interaction analyses assessed how baseline characteristics influenced the effect of Levodopa on fatigue occurrence. The results are presented in forest plots as odds ratios with corresponding 95% confidence intervals.

High impact reason: This study is among the largest examining levodopa’s effect on PSF compared to placebo during in-hospital rehabilitation.

Results: This study included 456 participants (median age 73 years, 59% male), 235 receiving levodopa and 221 placebo. At five weeks, the frequency and odds of PSF did not differ significantly between the levodopa group (28%) and the placebo group (30%) (OR: 1.14, 95% CI: 0.76–1.64). The impact of levodopa did not differ significantly across the subgroups analyzed in the interaction analysis. In conclusion, in the ESTREL-Fatigue study, treatment with levodopa had no impact on PSF.

Disclosure of interest: May Zin Myint : Nothing to disclose

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 05.02 - SECONDARY PREVENTION

P1093 - ESOC2025-LB-262

CROSS-SECTORAL, COORDINATED TREATMENT OF STROKE PATIENTS WITH PATIENT-ORIENTED OUTCOME MEASUREMENT (STROCARE) – FINAL RESULTS OF A MULTI-CENTER SEQUENTIALLY CONTROLLED INTERVENTIONAL STUDY

Rafael Bourry¹, Levente Kriston¹, Theresa Schrage¹, Jonas Petter¹, Janina Molder², Stefan Boskamp³, Martin Härter¹, Kathrin Harringa¹, Michael Rosenkranz³, Holger Schmidt², Andreas Beisel¹, Judith Dams¹, Hans-Helmut König¹, Götz Thomalla¹

¹University Medical Center Hamburg-Eppendorf, Hamburg, Germany, ²Elbe Kliniken Stade, Stade, Germany, ³Albertinen Krankenhaus, Hamburg, Germany

Background: Secondary stroke prevention remains a challenge in stroke care, with impaired quality of life (QoL) and persistently high rates of recurrent events. The aim of the StroCare study was to improve QoL after stroke by implementing an optimized cross-sectoral, coordinated care program for stroke patients.

Case Report / Trial: StrokeCare was a multi-center mixed method sequentially controlled intervention study including patients for acute ischaemic or haemorrhagic stroke or transient ischaemic attack. During the control period of 12 months, patients received standard of care. In the following intervention period of 24 months, patients received a case manager and repeated outpatient visits with specialized stroke teams, who defined and repeatedly adapted individualized treatment targets. The primary outcome was self-reported physical health, measured by the PROMIS-10 at 24 months. Secondary outcomes comprised functional outcome assessed by the modified Rankin Scale (mRS).

High impact reason: A cross-sectoral, coordinated treatment program for post-stroke care across multiple German stroke centers did not improve self-reported physical health at 24 months, but was associated with better functional outcome.

Results: 406 patients were enrolled at three German stroke centers (intervention: 194; control: 212). Demographics at baseline (female percentage 56.7% vs. 54.7%; median NIHSS: 2 vs. 1) were comparable between groups. At 24 months, estimated mean T-scores for PROMIS-10 were 42.0 (95%CI 40.6-43.4) in the intervention group and 41.0 (39.7-42.4) with an estimated mean difference of 0.95 (p=0.139). Patients in the intervention group reached lower mRS-scores at 24 months with an odds ratio of 0.54 (95%CI 0.35-0.83; p=0.004). Detailed results will be presented at the conference.

Disclosure of interest: (All).

02.00 - INTRACRANIAL HEMORRHAGE - 02.01 - INTRACEREBRAL HAEMORRHAGE

P1094 - ESOC2025-LB-501

NON-CONTRAST COMPUTED TOMOGRAPHY MARKERS OF HEMATOMA EXPANSION AND RESPONSE TO ANDEXANET IN FXA INHIBITOR-ASSOCIATED INTRACRANIAL HEMORRHAGE – SECONDARY ANALYSES OF ANNEXA-I

Koji Tanaka¹, Umberto Pensato^1,2, Mohamed Alshamrani¹, Ariesteidis Katsanos³, Pargol Balali⁴, Sucharita Ray¹, Scott Kasner⁴, Jan Beyer-Westendorf⁵, Danilo Toni⁶, Lizhen Xu³, Mikael Knutsson⁷, Per Ladenvall⁷, Mike Sharma³, Ashkan Shoamanesh³, Andrew Demchuk¹

¹Cumming School of Medicine, University of Calgary, Calgary, Canada, ²Humanitas University, Milan, Italy, ³Population Health Research Institute, McMaster University, Hamilton, Canada, ⁴University of Pennsylvania, Philadelphia, United States, ⁵University Hospital Dresden, Dresden, Germany, ⁶Sapienza University of Rome, Rome, Italy, ⁷Biopharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden

Background: Andexanet alfa is a modified recombinant FXa decoy that rapidly reverses the anticoagulant effect of FXa inhibitors (FXai). We aimed to investigate the prognostic utility of non-contrast CT (NCCT) markers of hematoma expansion (HE) in patients with acute FXai-associated ICH and whether the presence of these markers modify the effects of andexanet.

Case Report / Trial: Post-hoc secondary analyses of ANNEXa-I trial participants with qualifying ICH. Baseline NCCT markers of HE (fluid level; hypodensity; black hole; swirl, island, blend, and satellite signs; and Barras density scale) were evaluated. Multivariable logistic regression was performed to investigate associations between HE (⩾12.5mL or ⩾35% increase in hematoma volume between baseline and 12 hours after randomization) and NCCT markers with treatment interactions of andexanet.

High impact reason: The efficacy of andexanet was largely consistent regardless of NCCT markers in patients with acute FXai-associated ICH. Blend sign may identify patients who obtain greater benefit from andexanet, deserving further exploration.

Results: Among a total of 496 patients, HE was seen in 156 patients (31.4%). 306 (61.7%) patients had at least one HE marker, including fluid level (1.4%); hypodensity (29.8%); black hole (13.3%); swirl (55.4%), island (17.9%), blend (6.9%), and satellite (34.7%) signs; and/or Barras density scale III-V (14.9%). Associations between HE and NCCT markers were not significant after adjustment for other NCCT markers, time from symptom onset to scan, baseline hematoma volume, and diastolic blood pressure. A significant treatment interaction was observed favoring greater reduction in HE with andexanet (vs. usual care) in patients with blend sign (p = 0.011).

Disclosure of interest: MS, JK, CT, STE: None regarding the content of the trial.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

P1095 - ESOC2025-LB-508

TELEMEDICINE-BASED VERSUS ONSITE FOLLOW-UP VISITS IN ACUTE STROKE CARE — THE VISIT-STROKE STUDY

Janina Behrens^1,2, Maximilian Kaffes^1,2, Annette Aigner^2,3, Heinrich Audebert^1,2

¹Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Berlin, Germany, ²Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin, Berlin, Germany, ³Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany

Background:Telemedicine stroke networks provide a well-established solution to limited availability of 24/7 neurologist coverage in rural areas. While most tele-neurological consultations focus on acute stroke care—particularly timely administration of intravenous rtPA—neurological expertise remains crucial in the post-acute phase for determining stroke etiology, managing complications, initiating secondary prevention, and guiding rehabilitation. This study assessed non-inferiority of telemedicine compared to on-site follow-up visits regarding quality of medical recommendations for suspected stroke patients.

Case Report / Trial:We conducted a multi-center study at 15 hospitals across four German telemedicine networks. On-site follow-up visits were conducted by board-certified neurologists working in in- and outpatient settings, telemedicine follow-ups by telestroke neurologists. The primary outcome was the overall correctness of post-acute medical assessments and recommendations, based on six quality indicators (etiological classification, plausibility of neurological examination, risk assessment, recommended diagnostic measures, choice of secondary prevention, and recommended follow-up care), assessed by majority vote from three adjudication committee members, blinded to the type of follow-up visit.

High impact reason:First large trial to assess quality of telemedicine versus onsite follow-up visits in acute stroke patients.

Results:523 patients (median age: 71 years; 45.1% female) were recruited between October 2022 and January 2025. Upon submission, 393 cases had completed ratings and were available for preliminary analyses. Final diagnosis was stroke/TIA in 352 cases (89.6%). Median time difference between both visits was 3.00 hours (IQR: 17.50 - 1.75). Complete data analyses and conclusions will be provided and presented at ESOC.

Disclosure of interest: Tatiana Kharitonova was a medical expert of the study and was compensated by POLYSAN Scientific & Technological Pharmaceutical Company for her work on this research. Alexey Shmonin was a scientific advisor for this study and was compensated by POLYSAN Scientific & Technological Pharmaceutical Company for his work on this research. Diana Tokareva was a scientific advisor for this study and was compensated by POLYSAN Scientific & Technological Pharmaceutical Company for her work on this research. Igor Voznjuk was a scientific advisor for this study and was compensated by POLYSAN Scientific & Technological Pharmaceutical Company for his work on this research.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P1096 - ESOC2025-LB-573

ADJUNCTIVE INTRAARTERIAL THROMBOLYSIS AFTER THROMBECTOMY IN LARGE VESSEL OCCLUSION STROKE: A META-ANALYSIS OF RANDOMIZED TRIALS

Mohammed Almekhlafi¹, Hyungjong Park², Bijoy Menon¹

¹Dept of Clinical Neurosciences, University of Calgary, Calgary, Canada, ²Department of Neurology, School of Medicine, Keimyung University, Keimyung, South Korea

Background:

Adjunctive intraarterial (IA) thrombolysis after endovascular thrombectomy (EVT) may enhance microvascular reperfusion in large vessel occlusion (LVO) stroke, but trial results conflict. This meta-analysis evaluates efficacy and safety of IA thrombolytics post-EVT.

Case Report / Trial:

Published papers and abstracts of randomized trials using IA thrombolytics (tenecteplase, alteplase, urokinase) in anterior or posterior circulation LVO following successful reperfusion were included. Efficacy outcomes were defined as 90-day modified Rankin Scale (mRS) of 0-1 and mRS 0-2, and safety outcomes were mortality, and symptomatic intracranial hemorrhage (sICH). Odds ratios (OR) and 95% confidence interval (95% CI) were calculated and pooled using random-effects models.

High impact reason:

This meta-analysis provides the most comprehensive synthesis of randomized controlled trials evaluating IA thrombolysis as an adjunct to EVT. This will inform clinical decision-making, and supports the rationale for future large-scale confirmatory trials to optimize this treatment strategy.

Results:

Seven randomized trials involving 2,131 participants (China/Spain, 2022–2025) were included. IA thrombolytics was significantly associated with mRS 0-1 (OR 1.4, 95% CI 1.2–1.7, p<0.001). The benefits were driven by trials using alteplase (OR 1.9, 95% CI, 1.3-2.9, p=0.001) and tenecteplase (OR 1.4, 95% CI, 1.1-1.8, p=0.005), as well as in patients who did not receive IV thrombolysis (OR 2.7, 95% CI, 1.6-4.7, p<0.001), and those with incomplete (TICI2b) reperfusion (OR 1.6, 95% CI, 1.1-3.5, p=0.02). In contrast, trials of posterior circulation stroke or using urokinase were ineffective. There was no significant improvement on mRS 0-2 (OR 1.1, 95% CI 0.9–1.3). In safety outcomes, sICH and mortality did not differ overall.

Disclosure of interest: LB, JK, SE, CT: Nothing to disclose regarding the content of the ESTREL trial. Funding: Swiss National Science Foundation (SNSF).

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 05.01 - PREVENTION

P1097 - ESOC2025-LB-575

FLOSSING AND STROKE PREVENTION: EVIDENCE BEYOND CONFOUNDING BIAS, MEDIATED BY ORAL HEALTH AND REDUCED INFLAMMATION

Souvik Sen¹, Stefanie Wood¹, Julie Marchesan², Kevin Moss³, James Beck², Michelle Johansen⁴, Kamakshi Lakshminarayan⁵, Wayne Rosamond⁶

¹University of South Carolina School of Medicine, Prisma Health Midlands, Columbia, United States, ²Adams School of Dentistry, University of North Carolina at Chapel Hill, Division of Comprehensive Oral Health, Periodontology, Chapel Hill, United States, ³Indiana University, Bloomington, United States, ⁴Johns Hopkins University School of Medicine, The Welch Center, Bloomberg School of Public Health, Baltimore, United States, ⁵University of Minnesota, Minneapolis, United States, ⁶Gillings School of Global Public Health, Chapel Hill, United States

Background: Previously, we showed that dental flossing is associated with a reduced risk of incident ischemic stroke. However, due to potential bias, causal inferences could not be made. Using data from the Atherosclerosis Risk in Communities (ARIC) cohort, we conducted propensity score (PS) matching to mitigate bias. Additionally, we performed mediation analyses to provide insight into the causal pathway.

Case Report / Trial: In the ARIC study, home flossing use and flossing frequency per week were assessed through a structured questionnaire, along with covariates, oral health status, and inflammatory markers. PS were generated using logistic regression with relevant covariates, including age, BMI, gender, race, hypertension, diabetes, education level, smoking status, and drinking status. We used greedy matching with a caliper of 0.2 to pair flossers (treatment group) with non-flossers (control group). Mediation analysis was conducted to examine the pathway between flossing frequency and stroke through oral health and inflammation.

High impact reason: The results strengthen the causal inference between dental flossing and a reduced risk of stroke through PS matching and mediation analysis. These findings suggest that regular flossing may help prevent strokes by modulating inflammation-related pathways.

Results: Of the 6,278 dentate ARIC participants, we used PS matching to create a sample of non-flossers matched with flossers (2,147 in each group). Over a 20+ year follow-up period, flossers had a reduced risk of ischemic stroke (HR: 0.78, 95% CI: 0.63-0.97), as shown in Figure 1. Mediation analysis supported that the effect of flossing frequency on stroke was mediated through the pathway: floss frequency→oral health→inflammation→stroke (Figure 2).

Disclosure of interest: All authors: nothing to disclose

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.01 - REHABILITATION

P1098 - ESOC2025-LB-64

THE IMPACT OF LEVODOPA ON POST-STROKE DEPRESSION - THE ESTREL (ENHANCEMENT OF STROKE REHABILITATION WITH LEVODOPA) - DEPRESSION STUDY

Mirjam Sauter^1,2, Josefin E. Kaufmann^1,2, Christopher Kenan Traenka^1,2, Stefan Engelter^1,2, For the Estrel Investigators¹

¹Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland, ²Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland

Background: Post-stroke depression (PSD) occurs frequently after acute stroke and negatively affects rehabilitation. This study investigated whether levodopa, compared to placebo, impacts PSD during in-hospital rehabilitation.

Case Report / Trial: ESTREL-Depression utilized data from the multicenter, randomized, double-blind, placebo-controlled ESTREL (Enhancement of Stroke REhabilitation with Levodopa) trial. Participants with an acute stroke were randomly assigned to receive either levodopa/carbidopa (100/25mg) or placebo three times daily for 39 days. All ESTREL-participants with (i) information about the presence of depression at three months and (ii) who took at least 80% of the study medication were eligible for this study. Participants who had a history of depression were excluded. Depression was defined as a T-score of ⩾55 in the PROMIS Depression Short Form-4a after three months. Logistic regression was used to evaluate the odds of depression in both treatment groups. Interaction analyses assessed how baseline characteristics influenced the effect of Levodopa on depression occurrence. The results are presented in forest plots as odds ratios with corresponding 95% confidence intervals.

High impact reason: This study is among the largest examining levodopa’s effect on PSD compared to placebo during in-hospital rehabilitation.

Results: The study included 407 participants (mean age 71, 60% male), 209 receiving levodopa and 198 placebo. At three months, the frequency and odds of PSD did not differ significantly between the levodopa group (26%) and the placebo group (28.3%) (OR=0.93, 95% CI 0.60-1.43). The impact of levodopa did not differ significantly across the subgroups analyzed in the interaction analysis. In conclusion, in the ESTREL-Depression study, treatment with levodopa had no impact on PSD.

Disclosure of interest: Bourry, Rafael: Nothing to disclose; Kriston, Levente: Sourced funding with the Innovation Fund of the German Federal Joint Committee; Schrage, Theresa: Nothing to disclose; Petter, Jonas: Nothing to disclose; Molder, Janina: Nothing to disclose; Boskamp, Stefan: Nothing to disclose; Härter, Martin: Sourced funding with the Innovation Fund of the German Federal Joint Committee; Harringa, Kathrin: Nothing to disclose; Rosenkranz, Michael: Nothing to disclose; Schmidt, Holger: Nothing to disclose; Beisel, Andreas: Nothing to Disclose; Dams, Judith: Nothing to Disclose; König, Hans-Helmut: Nothing to disclose; Thomalla, Götz: Sourced funding with the Innovation Fund of the German Federal Joint Committee

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

P1099 - ESOC2025-LB-450

ALBUMIN FOR PATIENTS WITH ACUTE LARGE VESSEL OCCLUSIVE STROKE UNDERGOING ENDOVASCULAR TREATMENT (ARISE): A MULTICENTER, RANDOMIZED DOUBLE-BLIND, PLACEBO-CONTROLLED CLINICAL TRAIL

Yuanyuan Liu¹, Chuanjie Wu^1,2, Xiao Dong¹, Chuanhui Li¹, Zhengfei MA³, Di Wu⁴, Chen Zhou², Yi Xu¹, Xunming Ji¹

¹Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China, ²Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China, ³Suzhou Municipal Hospital, Suzhou, China, ⁴China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China., Beijing, China

Background: Albumin (ALB) is a multifunctional plasma protein and suggested to play a role in acute ischemic stroke (AIS). The efficacy of ALB has been demonstrated in preclinical studies that ALB could act on complex pathophysiological cascade of ischemia. In a multicenter, phase Ⅲ clinical trial testing the efficacy of ALB for AIS patients, ALB did not show clinical benefit. In this trial, only 21% of subjects received endovascular treatment (EVT). However, in recent years, the Stroke Therapy Academic Industry Round Table X recommended that future clinical studies should make EVT as an inclusion criterion. However, there are no studies on ALB included patients totally receiving EVT, leaving a research gap of whether ALB works better combined with EVT. ClinicalTrials.gov:NCT06538844.

Case Report / Trial: ARISE is an multicentre, randomized, phase 2 study. We included patients who aged 18-80 years, had AIS due to large vessel occlusion in the anterior circulation within 24 hours from symptom onset. Patients are randomly assigned, in a 1:1 ratio, to undergoing EVT and receive albumin therapy (0.5g/kg estimated body weight; intravenously injection) or to undergoing EVT and receive placebo therapy once daily for 4 days. The primary efficacy outcome was the change in infarct volume relative from baseline to day 5.

High impact reason: The ARISE trial will provide valuable evidence on the efficacy and safety of ALB in patients with AIS receiving EVT.

Results: Recruitment of subjects has now been completed. The final resluts of the ARISE study will be available in May 2025 for presentation at the ESOC.

Disclosure of interest: Yuanyuan Liu: nothing to disclose, Chuanjie Wu: nothing to disclose, Xiao Dong: nothing to disclose, Chuanhui Li: nothing to disclose,Zhengfei Ma: nothing to disclose, Di Wu: nothing to disclose, Chen Zhou: nothing to disclose, Yi Xu: nothing to disclose, Xunming Ji: nothing to disclose

Official welcome & Large Clinical Trials

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.03 - HYPERACUTE MANAGEMENT

O001 - ESOC2025-LB-46

THE MAIN OPTIMAL POST RTPA-IV MONITORING IN ISCHEMIC STROKE TRIAL (OPTIMISTMAIN): RESULTS OF AN INTERNATIONAL, PRAGMATIC, STEPPED WEDGE, CLUSTER RANDOMIZED CONTROLLED TRIAL

Victor C. Urrutia¹, Deborah Summers², Menglu Ouyang, Yi Sui³, Brenda Johnson¹, Laurent Billot⁴, Alejandra Malavera⁴, Paula Muñoz Venturelli⁵, Diana Day⁶, Lili Song⁷, Thompson Robinson⁸, Wan Asraf Wan Zaidi⁹, Pooja Khatri¹⁰, Xia Wang⁴, Craig Anderson

¹Johns Hopkins University School of Medicine, Baltimore, United States, ²Saint Luke’s Hospital of Kansas City, Kansas City, United States, ³Shenyang First People’s Hospital, Shenyang, China, ⁴The George Institute for Global Health, Sydney, Australia, ⁵Clinica Alemana Universidad del Desarrollo, Santiago, Chile, ⁶Anglia Ruskin University, Cambridge, United Kingdom, ⁷Fudan University, Shanghai, China, ⁸University of Leicester, Leicester, United Kingdom, ⁹Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpar, Malaysia, ¹⁰University of Cincinnati, Cincinnati, United States

Background: Careful monitoring of patients after intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) is resource-intensive, sleep disruptive, and potentially less relevant in those at low-risk of symptomatic intracerebral hemorrhage (sICH).

Case Report / Trial: OPTIMISTmain was an international, multicenter, prospective, stepped wedge, cluster randomized, blinded outcome assessed trial that aimed to determine if less-intensity monitoring is at least as effective (non-inferior) as standard high-intensity monitoring in stable post-IVT AIS patients with a mild deficit (NIHSS <10). Recruitment (mean 15 patients per 4 periods) at 120 hospitals was estimated to provide 90% power (one-sided α 0.025) to reject a non-inferiority margin of 1.15 for relative risk (RR) of ‘unfavorable functional outcome’ (mRS 2-6) at 90 days (from 50% to 57.5%), which corresponded to loss of IVT efficacy by low-intensity monitoring. Secondary outcomes included mRS shift, hospital LOS, HRQoL, sICH and SAEs. Primary analysis used a generalized linear mixed model with fixed effects of time and participant assignment, random effect of hospital, and multiple imputation of missing outcomes.

High impact reason: OPTIMISTmain aims to provide Level I evidence for the safety and effectiveness of a low-intensity post-IVT monitoring after AIS.

Results: A total of 4756 participants (mean age 66 y; female 39%, Asian 50%; median NIHSS score 4 [3-7]) were included at 118 hospitals in Australia, China, Chile, Malaysia, Mexico, Vietnam, UK, and US, between April 2021 and September 2024: 1969 and 2787 allocated to standard monitoring and low-intensity monitoring, respectively. Results to be presented.

Disclosure of interest: Funding paid to the investigators' institutions has been received from the National Health and Medical Research Council (NHMRC) of Australia; New South Wales Health Investigator Development Grant, UNSW Medicine non communicable diseases (NCD) theme E/MCR Seed Grant Scheme, the Medical Research Future Fund (MRFF, ID F02176) for conduct in Australia; and Genentech, Inc for conduct in the US. The authors report no other conflicts of interest.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

O002 - ESOC2025-LB-363

ADVANCING STROKE SAFETY AND EFFICACY THROUGH EARLY TIROFIBAN ADMINISTRATION AFTER INTRAVENOUS THROMBOLYSIS: THE ASSET-IT RANDOMIZED CLINICAL TRIAL

Chunrong Tao¹, Jun Sun¹, Yuyou Zhu¹, Rui Li¹, Tianlong Liu¹, Thanh N. Nguyen², Jeffrey Saver³, Nogueira Raul G⁴, Wei Hu¹

¹the first affiliated hospital of USTC, Hefei, China, ²Boston Medical Center, Boston, United States, ³David Geffen School of Medicine, Los Angeles, United States, ⁴UPMC Stroke Institute, Pittsburgh, United States

Background: Intravenous thrombolysis (IVT) is the cornerstone treatment for the acute ischemic stroke (AIS) within 4.5 hours after onset. Current guidelines recommend administering antiplatelet medications 24 hours after IVT. However, vascular re-occlusion is a common occurrence after IVT. Whether early administration of tirofiban could improve clinical outcomes in patients with AIS who received IVT is unclear.

Case Report / Trial: We conducted a phase 3, randomized, placebo-controlled, double-blind clinical trial across 39 centers in China. Patients with acute non-cardioembolic stroke who received IVT within 4.5 hours of symptom onset were randomly assigned to receive either intravenous tirofiban or placebo within 60 minutes of completing thrombolysis. The primary efficacy outcome was the proportion of patients achieving a 90-day modified Rankin Scale score of 0-1. The primary safety outcomes were symptomatic intracranial hemorrhage at 24 hours post-randomization and 90-day mortality.

High impact reason: The ASSET-IT trial concluded recruitment in less than a year, achieving its goal of consecutive enrollment at experienced centers while adhering to the highest scientific standards. This trial aims to evaluate the safety and efficacy of early intravenous tirofiban in patients with acute non-cardioembolic stroke, determining whether its early use as a first-line antiplatelet drug could improve outcomes. The full results of the ASSET-IT trial will be presented at ESOC 2025.

Results: A total of 832 patients were enrolled between March 14, 2024, and September 25, 2024. The mean (SD) age was xx years, the median [IQR] baseline NIHSS score was xx [yy-zz]. Outcome data collection is complete, and analyses are underway.

Disclosure of interest: All authors: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

O003 - ESOC2025-LB-423

EFFECT OF INTERLEUKIN-6 RECEPTOR INHIBITION IN PATIENTS WITH ISCHEMIC STROKE UNDERGOING ENDOVASCULAR TREATMENT (IRIS)

Xuehong Chu¹, Chuanjie Wu¹, Zhengfei MA², Yan Feng², Chen Zhou³, Chuanhui Li¹, Wenbo Zhao¹, Xunming Ji¹

¹Xuanwu Hospital, Capital Medical University, Beijing, China, ²Suzhou Municipal Hospital, Su Zhou, China, ³Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China

Background: Preclinical studies show that inhibiting the interleukin-6 receptor (IL-6R) signaling pathway reduces infarct volume and improves outcomes in cerebral ischemia-reperfusion models. This study evaluated tocilizumab, an anti-IL-6R antibody, in patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO) scheduled for endovascular treatment (EVT).

Case Report / Trial: The IRIS trial is a phase 2, multicenter, randomized, double-blind, placebo-controlled study assessing tocilizumab as an adjunct to EVT in AIS patients. Participants were randomized 1:1 to receive a single intravenous dose of tocilizumab (240 mg) or placebo within 24 hours of stroke onset. The primary endpoint is the change in infarct core volume from baseline to 72 hours post-treatment. Secondary endpoints include 90-day functional independence (modified Rankin Scale score ⩽2), early neurological improvement, and safety outcomes.

High impact reason: This is the first trial to investigate tocilizumab combined with EVT for AIS. By targeting IL-6-mediated inflammation in ischemia-reperfusion injury, tocilizumab may reduce infarct volume and improve outcomes. If successful, it could establish a novel therapeutic strategy for AIS, addressing a critical unmet need and potentially influencing clinical guidelines.

Results: From January 2024 to June 2024, 108 subjects were enrolled. Primary endpoint evaluation will be conducted by an independent core lab and clinical outcome committee. Demographic data, safety profiles, and preliminary efficacy results will be presented.

Disclosure of interest: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

O004 - ESOC2025-LB-527

MISMATCH AND SAVED BRAIN TISSUE VOLUME IN PATIENTS WITH A MEDIUM/DISTAL VESSEL OCCLUSION STROKE: A SUB-ANALYSIS OF THE DISTAL TRIAL

Aikaterini Anastasiou¹, Helene Corbaz¹, Alex Brehm¹, Evangelia Christodoulou¹, Nikki Rommers¹, Urs Fischer, Marios Psychogios¹, on Behalf of the Distal Investigators*¹

¹Department of Neuroradiology, University Hospital Basel, Basel, Switzerland

Background: The recent randomized controled trials showed that endovascular therapy (EVT) in patients with an acute ischemic stroke (AIS) due to a medium distal vessel occlusion (MDVO) did not lead to better outcomes at 90 days than best medical treatment (BMT) alone.

Case Report / Trial: We based our analysis on the data collected from the DISTAL Trial.

We used the available imaging data of those patients. The ischemic core at baseline (CBF<30%), the tissue at risk at baseline (Tmax>6sec) and the demarcation on the follow-up imaging (within the first 24h) were segmented.

The primary outcome is the mRS at 90 days and the secondary outcome is the relative difference in brain tissue volume saved between baseline and follow up imaging.

High impact reason: Discussions has already arisen regarding patient selection for EVT in MDVO. CT or MR perfusion might assist in the selection of eligible patients.

We assessed the hypothesis that EVT plus BMT compared to BMT alone in patients with a bigger mismatch volume, leads to better mRS at 90 days and additionally to a bigger volume of saved brain tissue.

Results: 447 patients had eligible imaging. Using the hurdle model, we found that BMT plus EVT is associated with a 1.901 times higher odds for having a follow-up volume of 0 mL compared to BMT alone. When the follow-up volume is not 0, BMT plus EVT does not appear to be associated with the relative difference in volume.

The results of the analysis for the primary outcome will be available at ESOC 2025.

Disclosure of interest: Marios-Nikos Psychogios has received research grants from the Swiss National Science Foundation and industry support from Stryker, Medtronic, Phenox, Penumbra, and Rapid Medical for the DISTAL trial. He has also received speaker fees from multiple medical companies and has a research agreement with Siemens Healthineers. Urs Fischer has received research funding from the Swiss National Science Foundation, Swiss Heart Foundation, Boehringer Ingelheim, Rapid Medical, Phenox, Penumbra, Stryker, and Medtronic, with all fees paid to his institution. He has served as Principal Investigator (PI) or Co-PI for trials including ELAN, DISTAL, TECNO, and SWIFT DIRECT, and has received consultancy fees from Boehringer Ingelheim, CSL Behring, and Medtronic, paid to his institution. Additionally, he has held advisory roles with Alexion/Portola, Boehringer Ingelheim, Biogen, and Acthera, and has participated in clinical event committees and data safety monitoring boards for various trials. He also serves as President of the Swiss Neurological Society and President-Elect of the European Stroke Organisation.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

O005 - ESOC2025-LB-498

Association of Imaging Features with Prognosis and Effect of Reperfusion Therapies in Patients with Medium Vessel Occlusion Stroke

Michael Hill¹, Johanna Ospel¹, David Volders², Mouhammad Jumaa³, Dar Dowlatshahi⁴, Markus Moehlenbruch⁵, Shahid Nimjee⁶, Mayank Goyal¹

¹University of Calgary, Calgary, Canada, ²Dalhousie University, Halifax, Canada, ³University of Toledo, Toledo, United States, ⁴University of Ottawa, Ottawa, Canada, ⁵Heidelberg University Hospital, Heidelberg, Germany, ⁶Ohio State University, Columbus, United States

Background: The ESCAPE-MeVO trial sought to evaluate the efficacy and safety of endovascular treatment (EVT) for acute stroke due to medium vessel occlusion stroke (MeVO). Patients were randomized to EVT in addition to best medical management or best medical management alone, and the trial showed no difference in outcomes between both arms. However, MeVO stroke patients are a heterogenous patient population with regard to their clinical presentation, occlusion location and imaging characteristics. This post-hoc analysis assesses associations with imaging characteristics of MeVO stroke patients with their prognosis and intravenous thrombolysis (IVT) and EVT treatment effect.

Case Report / Trial: ESCAPE-MeVO trial

High impact reason:Results were only presented at ISC 2025 and subgroup analysis, which will guide endovascular treatment selection for medium vessel occlusion stroke, are presented in this abstract.

Results: All 529 participants of the intention-to-treat population were included. Most MeVOs (442/522[84.7%]) were located in the MCA territory, and M3 segment was the single most common MeVO location (n=216[41.4%]). Median diameter of the occluded vessel segment was 1.9 mm (interquartile range 1.7-2.2). Collateral status was good in 129/517(24.4%), moderate in 276/517(52.2%) and poor in 111/517 (21.0%). CTA-based collateral status was the only imaging variable associated with the primary outcome in uni-variable analysis (common OR 0.75 [95%CI 0.62-0.89]), with a non-significant trend in multi-variable analysis (adjusted common OR 0.82 [95%CI 0.67-0.998]). While there was a possible, weak signal towards improved IVT efficacy with M3 and A3 occlusions, no modification of EVT effect was seen.

Disclosure of interest: All authors: Escape-MEVO PIs (Mayank Goyal, Michael Hill) or site PIs (remaining authors).

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.01 - REHABILITATION

O006 - ESOC2025-LB-145

EFFECTIVENESS OF PREDISCHARGE OCCUPATIONAL THERAPY HOMEVISITS AFTER STROKE: A PROSPECTIVE, BLINDED ENDPOINT, RANDOMISED CONTROLLED TRIAL (HOME REHAB)

Natasha Anne Lannin^1,2, Avril Drummond³, Leonid Churilov⁴, Lindy Clemson⁵, Maria Crotty⁶, Ian Cameron⁵, Emma Schneider^2,7, Kate Laver⁶, Mandy Stanley⁸, Sandra Reeder¹, Nadine Andrew¹, Rebecca Nicks⁹, Brynn Lewin¹⁰, Lorrie Mohsen¹⁰, Dominique A. Cadilhac¹

¹Monash University, Melbourne, Australia, ²Alfred Health, Melbourne, Australia, ³School of Health Sciences, The University of Nottingham, Nottingham, United Kingdom, ⁴University of Melbourne, Department of Medicine, Melbourne, Australia, ⁵University of Sydney, Sydney, Australia, ⁶Flinders University, Adelaide, Australia, ⁷Swinburne University of Technology, School of Health Sciences, Melbourne, Australia, ⁸Edith Cowan University, Perth, Australia, ⁹Eastern Health, Melbourne, Australia, ¹⁰Mt Wilga Private, Ramsay Healthcare, Sydney, Australia

Background: Predischarge occupational therapy home visits are recommended in clinical practice guidelines to support safe discharge from rehabilitation to home after first stroke, despite limited trial evidence to support this recommendation.

Case Report / Trial: We compared an enhanced, occupational therapist-led predischarge home visit (EXP) to in-hospital predischarge planning (CON) in a prospective, phase III randomized, blinded endpoint trial with concealed allocation and intention-to-treat analysis. Stroke survivors aged ⩾45 years, admitted to a rehabilitation ward and expected to return to a community (private) dwelling after discharge were randomly allocated 1:1 to receive the experimental or control intervention. The primary outcome is participation measured using the Nottingham Extended Activities of Daily Living (NEADL); secondary outcomes include readmission, disability, and health-related quality of life.

High impact reason: Definitive rehabilitation randomized clinical trial which will address a known gap in current stroke care, determining the effect of a common yet untested intervention.

Results: Recruitment completed in November 2024. 307 participants from 11 sites in 4 states of Australia were randomized (EXP n = 152; CON n = 155). Receiving the comprehensive occupational therapist led home visit was not associated with greater performance of extended activities of daily living (mean difference on NEADL 0.96 (-1.88, 3.81)) and we found no significant effect on key secondary outcomes. Based on the primary outcome, there is >99% frequentist confidence that the change in participation in the eexperimental group is not clinically meaningfully higher than that in the active control group. These findings may warrant reconsideration the practice of predischarge home visits.

Disclosure of interest: Natasha A. Lannin: The study was supported by the National Health and Medical Research Council (grant number GNT1141561), and she is supported by National Heart Foundation of Australia (GNT106762); Lindy Clemson: Nothing to disclose; Leonid Churilov: Nothing to disclose; Avril Drummond: Nothing to disclose; Maria Crotty: Nothing to disclose; Ian D. Cameron: Nothing to disclose; Emma Schneider: Nothing to disclose; Kate Laver: Nothing to disclose; Mandy Stanley: Nothing to declare; Sandra Reeder: Nothing to declare; Nadine Andrew: Nothing to disclose; Rebecca Nicks: Nothing to disclose; Brynn Lewin: Nothing to disclose; Lorrie Mohsen: Nothing to disclose; Dominique Cadilhac: Nothing to Nothing to disclose

02.00 - INTRACRANIAL HEMORRHAGE - 02.01 - INTRACEREBRAL HAEMORRHAGE

O007 - ESOC2025-LB-214

SHOULD ANTITHROMBOTIC TREATMENT BE PRESCRIBED AFTER AN INTRACEREBRAL HAEMORRHAGE? – MAIN RESULTS FROM THE STUDY OF ANTITHROMBOTIC TREATMENT AFTER INTRACEREBRAL HAEMORRHAGE (STATICH)

Helle Eilertsen^1,2, Kristin Larsen^2,3, Else Charlotte Sandset¹, Elisabeth Forfang², Johanna Pennlert⁴, Eva-Lotta Glader⁴, Christina Kruuse⁵, Per Wester⁴, Hege Ihle-Hansen¹, Maria Carlsson^6,7, Jurate Saltyte Benth², Rustam Salman⁸, Torgeir Bruun Wyller^1,2, Ole Morten Ronning^2,3

¹Oslo University Hospital, Oslo, Norway, ²University of Oslo, Oslo, Norway, ³Akershus University Hospital, Lørenskog, Norway, ⁴Norrlands Universitetssjukhus, Umeå, Sweden, ⁵Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark, ⁶Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway, ⁷Nordland Hospital Trust, Bodø, Norway, ⁸Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom

Background: People with spontaneous intracerebral haemorrhage (sICH) often have indications for antithrombotic agents for prevention of ischaemic events but these agents might increase the risk of new sICH. Guidelines have been unable to make strong recommendations regarding starting or avoiding antithrombotic agents after sICH. We aimed to assess the effects of long-term antithrombotic treatment on the risk of recurrent sICH and other haemorrhagic and ischaemic events after sICH.

Case Report / Trial: STATICH (EudraCT 2014-002636-13) was a Scandinavian, multicentre, randomised, open, blinded endpoint trial of starting versus avoiding antithrombotic treatment in adults surviving sICH who had indication for antithrombotic treatment. The planned sample size was 500 participants. Participants were included in one of two separate trials: patients with vascular disease were randomised to antiplatelet or no antithrombotic treatment and patients with atrial fibrillation were randomised to anticoagulant or no anticoagulant treatment.

High impact reason: STATICH was a randomised controlled trial on antithrombotic treatment after sICH, a topic where no clear guidelines yet exist.

Results:134 patients were included from June 2018 until December 2022. In the antiplatelet trial, 69 patients were included, the median age was 75 [45-89] years, and 75% had a previous ischaemic stroke or TIA. In the anticoagulant trial, 65 patients were included, the median age was 79 [54-91] years, and 26% had a previous ischaemic stroke or TIA. The primary outcome was time to recurrent sICH within two-year follow-up. Due to lack of resources and early trial termination, four patients did not reach two-year follow-up. Conclusions: Final results will be presented at ESOC 2025.

Disclosure of interest: Helle Eilertsen: nothing to disclose. Kristin T. Larsen: nothing to disclose. Elisabeth Forfang: nothing to disclose. Johanna Pennlert: nothing to disclose. Eva-Lotta Glader: nothing to disclose. Christina Kruuse: local PI in clinical trials by Bayer A/S and BMS A/S, speakers fee Lundbeck A/S, PI with research grants from Novo Nordisk Foundation on ETLAS-trial (NNF20OC0063912), PRATICE trials (NNF19OC0058812) and Borregaard stipend (NNF18OC0031840). Per Wester: nothing to disclose. Hege Ihle-Hansen: Speakers fee AstraZeneca. Maria Carlsson: Speakers fee AstraZeneca. Jurate Saltyte Benth: nothing to disclose. Rustam Al-Shahi Salman: chief investigator of RESTART (ISRCTN71907627) and is the chief investigator of ASPIRING (ISRCTN16705062), both funded by the British Heart Foundation. Torgeir B. Wyller: nothing to disclose. Ole Morten Rønning: nothing to disclose.

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 05.02 - SECONDARY PREVENTION

O008 - ESOC2025-LB-69

EXTENDING ORAL ANTICOAGULATION TREATMENT AFTER ACUTE CEREBRAL VEIN THROMBOSIS: 12-MONTH RESULTS OF THE EXCOA-CVT CLUSTER-RANDOMIZED TRIAL

Bruno Miranda¹, João Miguel A. Oliveira², Diana Aguiar de Sousa³, Sanjith Aaron⁴, Jonathan Coutinho⁵, Antonio Arauz Gongora⁶, Marta Carvalho⁷, Jukka Putaala⁸, Adriana Conforto⁹, Elyar Sadeghi Hokmabadi¹⁰, Miguel Barboza¹¹, Patrıcia Canhao¹², Marialuisa Zedde¹³, Faouzi Belahsen¹⁴, Afshin Borhani Haghighi¹⁵, Y. Muralidhar Reddy¹⁶, Patrik Michel¹⁷, Andreia Veiga¹⁸, Jose Férro¹⁹

¹Institute of Physiology, Lisbon School of Medicine - University of Lisbon, Lisbon, Portugal, ²Unidade Local de Saúde Almada-Seixal, Almada, Portugal, ³Centro Hospitalar Universitário Lisboa Central—ULS São José, Instituto de Anatomia and CEEM, Faculdade de Medicina da Universidade de Lisboa, Lopes Lab, Gulbenkian Institute of Molecular Medicina, Lisbon, Portugal, ⁴Christian Medical College and Hospital, Vellore, India, ⁵Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands, ⁶Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico, ⁷Serviço de Neurologia, Unidade Local de Saúde São João, Departamento de Neurociências Clínicas e Saúde Mental, Faculdade de Medicina da Universidade do Porto, Porto, Portugal, ⁸Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland, ⁹Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ¹⁰Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, ¹¹Neurosciences Department, Hospital Dr Rafael A Calderón Guardia, San José, Costa Rica, ¹²Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal, ¹³Stroke Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy, ¹⁴Department of Neurology, Hassan II University Hospital, Fez, Morocco, ¹⁵Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, ¹⁶Department of Neurology, CARE Hospital, Banjara Hills, Hyderabad, India, ¹⁷Stroke Center, Neurology Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland, ¹⁸Department Neurology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal, ¹⁹Neurology Department, ULS Santa Maria, Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

Background: After cerebral vein thrombosis (CVT), there is an increased risk of venous thromboembolic events (VTEs), but the optimal duration of oral anticoagulation (OAC) remains uncertain.

Case Report / Trial: EXCOA-CVT (ISRCTN25644448) is a multicenter, prospective study that included both a cluster-randomized trial and a parallel observational study for centers with pre-established policies. The study compared short-term (3-6 months) vs. long-term (12 months) OAC for secondary prevention after CVT, with follow-up at 6, 12, and 24 months. The primary efficacy outcome was symptomatic VTE, including recurrent CVT. Primary safety outcomes included bleeding events and all-cause mortality. The study started in 2014 and terminated early in December 2023.

High impact reason: EXCOA-CVT provides the first evidence on the optimal duration of secondary prevention after CVT from a large cluster-randomized trial, complemented by an observational cohort. The 12-month results will yield critical insights into the balance between recurrent thrombosis and bleeding risk, informing future management guidelines.

Results: A total of 1269 patients (62.6% female, mean age 39.4±14.2 years) were enrolled from 21 countries. Of these, 460 (36.2%) were cluster-randomized and 809 (63.8%) were in the observational arm. In the cluster-randomized arm, 233 patients (50.7%) were assigned to short-term policy and 227 (49.3%) to long-term OAC policy. In the observational arm, 514 (63.5%) were at centers with long-term policy. Follow-up at 6 months was completed in 96.0% of participants, including 94.4% in the cluster-randomized group. At 12 months, follow-up was available for 92.8% of the randomized cohort and 95.2% in the observational arm. Primary outcomes at 12-month will be presented.

Disclosure of interest: Diana Aguiar de Sousa reports advisory board participation for Daiichi-Sankyo, Bayer, Organon and Johnson & Johnson, speaker fees from Astrazeneca, and grants from Astrazeneca foundation, FCT, MSD and European Society of Radiology. José Ferro reports Steering Committee participation in trials from Bayer and Daiichi-Sankyo. Jonathan Coutinho has received grants from Bayer and AstraZeneca, both paid to his employer. Jonathan Coutinho is co-founder and shareholder of TrianecT BV. Other authors: nothing to disclose.

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 05.03 - EPIDEMIOLOGY & RISK FACTORS

O009 - ESOC2025-LB-148

RISK FACTORS FOR DEMENTIA AND COGNITIVE IMPAIRMENT AFTER STROKE: MAIN RESULTS OF A 5-YEAR PROSPECTIVE MULTICENTRE COHORT STUDY

Jule Filler^1,2, Marios Georgakis^2,3, Marco Duering^2,4, Michael Goertler^5,6, Silke Wunderlich⁷, Matthias Endres^8,9,10, Inga Zerr^11,12, Gabor Petzold^13,14, Martin Dichgans^2,15,16

¹Graduate School for Systemic Neurosciences, Ludwig-Maximilians-University, Munich, Germany, ²Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany, ³Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States, ⁴Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland, ⁵Department of Neurology, University Hospital, Otto-von-Guericke University Magdeburg, Magdeburg, Germany, ⁶German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany, ⁷Department of Neurology, TUM School of Medicine, Technical University of Munich, Munich, Germany, ⁸German Center for Neurodegenerative Diseases (DZNE, Berlin), Berlin, Germany, ⁹Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany, ¹⁰Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany, ¹¹Universitätsmedizin Göttingen, Klinik für Neurologie, Göttingen, Germany, ¹²Cerman Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany, ¹³German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany, ¹⁴Department of Vascular Neurology, University Hospital Bonn, Bonn, Germany, ¹⁵German Center for Neurodegenerative Diseases (DZNE, Munich), Munich, Germany, ¹⁶Munich Cluster for Systems Neurology (SyNergy), Munich, Germany

Background: Stroke survivors are at high risk of cognitive impairment or dementia. We aimed to identify risk factors for post-stroke dementia (PSD) and cognitive impairment (PSCI) within 5 years after stroke.

Case Report / Trial: We conducted a prospective cohort study of stroke patients admitted to seven German tertiary stroke centres between 05/01/2011 and 01/31/2019 (DEDEMAS-DEMDAS study; NCT01334749). Dementia-free patients with ischaemic or haemorrhagic stroke underwent baseline and follow-up assessments over 5 years. The primary outcome was PSD. Secondary outcomes included early-onset PSD (⩽6 months), delayed-onset PSD (>6 months), and PSCI. Associations between baseline risk factors and PSD were assessed using Cox regression models adjusted for age, sex, education, and stroke severity.

High impact reason: We report the main results of the DEDEMAS-DEMDAS study in which we identified major novel modifiable risk factors for PSD, which could serve as potential targets for secondary prevention.

Results: Of 736 patients (67% male, mean age 68.0 years [SD 11.2], median NIHSS 3 [IQR 1-5]), 554 (75%) completed follow-up, contributing a total of 2899 person-years. Fifty-five patients developed PSD (5-year incidence: 8.3% [6.1-10.6]); 38% of them had early-onset and 62% delayed-onset PSD. PSD risk was associated with older age, stroke severity, lower educational attainment, cognitive and functional impairment, metabolic syndrome (MetS), diabetes, and small vessel disease markers (all p<0.05). While factors related to the severity of the index stroke were more strongly associated with early-onset PSD, MetS showed a stronger association with delayed-onset PSD. Associations between cardiometabolic risk factors and PSD remained robust when adjusting for recurrent stroke.

Disclosure of interest: Dr. Georgakis reports consulting for Tourmaline Bio and the Gerson Lehrman Group (GLG). Dr. Duering reports consulting for Roche, serving on a scientific advisory board for Biogen, and serving on an adjudication board for Hovid Berhad, all outside of the submitted work. Dr. Endres reported receiving grants from Bayer and fees paid to the Charité – Universitätsmedizin Berlin from Amgen, AstraZeneca, Bayer Healthcare, Boehringer Ingelheim, BMS, Daiichi Sankyo, Sanofi, and Pfizer, all outside the submitted work. Dr. Dichgans reports consulting for Woolsey pharmaceuticals and NEUVASQ Biotechnologies SA, all outside the submitted work. Dr. Inga Zerr: nothing to disclose. Dr. Gabor Petzold: nothing to disclose. Dr. Silke Wunderlich: nothing to disclose. Jule Filler: nothing to disclose. The DEMDAS study was funded by the German Center for Neurodegenerative Diseases (DEMDAS [MC002]). This work was supported by the Vascular Dementia Research Foundation and the German Research Foundation (DFG) as part of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy) and the Fondation Leducq1-22CVD01 (to Dr. Martin Dichgans); DFG under Germany’s Excellence Strategy – EXC-2049 – 390688087, BMBF-01KC2002A, DZNE-BN012 and -MC002, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) DZHK-81×1100217/122677 and -81Z0100209, Corona Foundation- SA199/10060/2014, and Fondation Leducq-AVD117181, Collaborative Research Center ReTune TRR295-424778381, Clinical Research Group KFO 5023 BeCAUSE-Y, project 2 EN343/16-1 (to Dr. Matthias Endres); an Emmy Noether grant (GZ: GE 3461/2-1, ID 512461526) and within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy, ID 390857198) by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG), a research grant from the Fritz-Thyssen Foundation (Ref. 10.22.2.024MN), and a research fellowship by the Hertie Foundation (Hertie Network of Excellence in Clinical Neuroscience, ID P1230035) (to Dr. Marios Georgakis).

Presidential Symposium Award & Large Clinical Studies

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

O010 - ESOC2025-LB-285

TENECTEPLASE IN CENTRAL RETINAL ARTERY OCCLUSION STUDy (TenCRAOS)

Stephen J. Ryan^1,2, Øystein Kalnes Jørstad^2,3, Claus Ziegler Simonsen⁴, Ansar Ahmad Roy¹, Petra Ijäs⁵, Daniel Strbian⁵, Andrej Netland Khanevski⁶, Robin Lemmens⁷, Thomas Truelsen⁸, Toke Bek⁹, Jørgen Krohn¹⁰, Michael Mazya¹¹, Kristian Lundsgaard Kraglund¹, Mona Skjelland^1,2, Moten C. Moe^2,3, Anne Hege Aamodt^1,2

¹Department of Neurology, Oslo University Hospital, Oslo, Norway, ²Department of Neuromedicine and Movement Science, The Norwegian University of Science and Technology, Trondheim, Norway, ³Department of Ophthlamology, Oslo University Hospital, Oslo, Norway, ⁴Department of Neurology, Aarhus University Hospital, Aarhus, Denmark, ⁵Department of Neurology, Helsinki University Hospital, Helsinki, Finland, ⁶Department of Neurology, Haukeland University Hospital, Bergen, Norway, ⁷Department of Neurology, UZ Leuven, Leuven, Belgium, ⁸Department of Neurology, Rigshospitalet, Copenhagen, Denmark, ⁹Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark, ¹⁰Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway, ¹¹Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Background:Central retinal artery occlusion (CRAO) is an ophthalmologic emergency that, without prompt reperfusion, bears high risk of permanent blindness. No evidence-based treatment is currently available. Whether prompt reperfusion with thrombolytic agents can improve the outcome in CRAO, as proved in ischemic stroke, remains unanswered. The main aim is to assess the effect of systemic tenecteplase within 4.5 hours of onset of central retinal artery occlusion.

Case Report / Trial: The trial is an ongoing prospective, randomised-controlled, double-dummy, double-blind phase 3 multi-centre trial of TNK 0.25 mg/kg + placebo vs. ASA + placebo.

Patients are recruited after an ophthalmologist has confirmed CRAO and they can be treated within 4.5hrs. The primary outcome is the proportion of patients with ⩽ 0.7 logMAR best-corrected visual acuity (BCVA) in the affected eye at 30 days after treatment, representing an improvement in BCVA of at least 0.3 logMAR.

High impact reason: TenCRAOS is establishing treatment pathways for CRAO in a research setting. The feasibility of incorporating acute thrombolysis for CRAO into clinical care, utilizing current acute stroke algorithms, will also be proven and can be readily incorporated. THEIA, which was recently completed with 70 participants from 16 recruiting sites in France and presented at the World Stroke Congress in 2024 with neutral results.

Results: We have recruited 76 patients so far, 32 in Norway, 19 in Denmark, 11 in Finland, 7 in Belgium, 4 in Lithuania and 3 in Sweden. Just 2 inclusions remain, and we expect the results will be presented at ESOC 2025.

Disclosure of interest: Nothing to disclose at the moment

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.03 - HYPERACUTE MANAGEMENT

O011 - ESOC2025-LB-352

EFFECT OF AN ARTIFICIAL INTELLIGENCE-BASED CLINICAL DECISION SUPPORT SYSTEM ON STROKE CARE QUALITY AND OUTCOMES IN PATIENTS WITH ACUTE ISCHEMIC STROKE (GOLDEN BRIDGE II)

Xinmiao Zhang^1,2, Lingling Ding^1,2, Jing Jing^1,2, Chunjuan Wang^1,2, Hongqiu Gu², Xia Meng^1,2, Man Xu³, Hao Li², Ying Xian⁴, Eric Peterson⁵, Gregg Fonarow⁶, Lee Schwamm⁷, Xingquan Zhao^1,2,8, Yongjun Wang^1,2,8, Zixiao Li^1,2,8

¹Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, ²China National Clinical Research Center for Neurological Diseases, Beijing, China, ³China National Clinical Research Center-Hanalytics Artificial Intelligence Research Centre for Neurological Disorders, Beijing, China, ⁴Department of Neurology, University of Texas Southwestern Medical Center, Dallas, United States, ⁵Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, United States, ⁶Division of Cardiology, University of California, Los Angeles, United States, ⁷Strategy and Transformation, Yale School of Medicine, New Haven, United States, ⁸Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China

Background:Artificial intelligence-based clinical decision support system (AI-CDSS) shows promise for improving healthcare delivery. We aimed to determine the efficacy of an AI-CDSS on stroke care quality and clinical outcomes among acute ischemic stroke (AIS) patients.

Case Report / Trial:We conducted a multicenter, cluster-randomized clinical trial among 77 hospitals in China from January 2021 to June 2023. Thirty-eight hospitals in the intervention group received AI-CDSS support including AI-assisted imaging analysis, stroke etiology classification, and evidence-based treatment recommendations and 39 hospitals in the control group provided usual care. This trial was registered on ClinicalTrials.gov (NCT 04524624).

High impact reason:Our study suggests AIS patients with AI-CDSS support had decreased new vascular events and improved stroke care quality compared to usual care, demonstrating a successful application of AI in cerebrovascular disease.

Results:Among 21,603 enrolled subjects with AIS (median age, 67.0 years; women, 7678 [35.5%]; intervention group, 11 054 patients; control group, 10 549 patients), 20 231 patients (95.7%) completed the 12-month follow-up. Patients in the intervention group had fewer new clinical vascular events at 3 months [2.9% vs 3.9%; adjusted hazard ratio 0.71 (95% confidence interval 0.62 to 0.83), P<0.001], 6 months [3.4% vs 4.8%; 0.70 (0.61 to 0.79), P<0.001] and 12 months [4.0% vs 5.5%; 0.70 (0.62 to 0.79), P<0.001], and fewer all-cause death at 6 months [2.0% vs 2.3%, 0.78 (0.65 to 0.93), P=0.007] and 12 months [3.0% vs 3.5%, 0.77 (0.66 to 0.89), P<0.001]. Patients in the intervention group were more likely to receive higher composite AIS quality score [91.4% vs 89.7%, 1.26 (1.19 to 1.33), P<0.001].

Disclosure of interest: Ying Xian: consulted for the American Heart Association and received research grants from the National Institutes on Aging and Genentech; Gregg C. Fonarow: consulted for Abbott, Amgen, AstraZeneca, Bayer, Boehinger Ingelheim, Cytokinetics, Eli Lilly, Johnson & Johnson, Medtronic, Merck, Novartis, and Pfizer; Lee H. Schwamm: scientific consultant regarding trial design and conducts to Genentech on late window thrombolysis and Member of steering committee (TIMELESS NCT03785678), consultant on user interface design and usability to LifeImage, member of Data Safety Monitoring Boards (DSMB) for Penumbra (MIND NCT03342664); Xinmiao Zhang, Lingling Ding, Jing Jing, Chunjuan Wang, Hongqiu Gu, Xia Meng, Man Xu, Hao Li, Eric. Peterson, Xingquan Zhao, Yongjun Wang, and Zixiao Li: nothing to disclose.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

O012 - ESOC2025-LB-506

SUMMIT MAX: A randomized trial to evaluate the safety and efficacy of the Monopoint Reperfusion System for Aspiration thrombectomy

Thanh N. Nguyen¹, Ben McGuinness², Ryan Priest³, Ansaar Rai⁴, Osama Zaidat⁵, Bradly Gross⁶, Ricardo Hanel⁷, M Shazam Hussain⁸, Daniel Tonetti⁹, Mohamad Abdalkader¹, Ronald Budzick¹⁰, Craig Kilburg¹¹, Keith Woodward¹², Albert Yoo¹³, Guilherme Dabus¹⁴

¹Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, United States, ²Auckland City Hospital, Auckland, United States, ³Oregon Health & Science University, Oregon, United States, ⁴West Virginia University, Morgantown, United States, ⁵Mercy Health St. Vincent Medical Center, Toledo, United States, ⁶University of Pittsburgh Medical Center, Pittsburgh, United States, ⁷Baptist Health Jacksonville, Jacksonville, United States, ⁸Cleveland Clinic, Cleveland, United States, ⁹Cooper University Healthcare, Camden, United States, ¹⁰Ohio Health, Riverside, United States, ¹¹University of Utah, Salt Lake City, United States, ¹²Fort Sanders Medical Center, Knoxville, United States, ¹³Medical City Plano, Plano, United States, ¹⁴Baptist Hospital of Miami, Miami, United States

Background: Rapid and complete recanalization is a primary goal in the endovascular treatment of large vessel occlusion stroke. The effectiveness and safety of large bore aspiration catheters (.088” inner diameter) for the treatment of large vessel occlusion stroke have not been demonstrated in a randomized trial.

Case Report / Trial:SUMMIT MAX Randomized trial

SUMMIT MAX was a prospective, randomized, open label clinical trial of patients with ICA and MCA M1 occlusions, comparing the large-bore Monopoint Reperfusion system (Route 92 Medical) to the Vecta Aspiration system (Stryker Neurovascular). We hypothesized that the effectiveness as measured by the reperfusion rate and safety of the Monopoint reperfusion system was non-inferior to the Vecta Aspiration system. The primary endpoint was successful reperfusion defined as mTICI ⩾ 2b after use of the assigned device adjudicated by an independent core lab. The primary safety endpoint was sICH within 24h(-8/+24) post-procedure.

High impact reason: Primary results of a randomized trial on aspiration catheters with Monopoint Reperfusion system verus Control group.

Results: There were 250 patients randomized of whom 156 met criteria for the modified intent-to-treat population: 89 in the Monopoint group and 77 in the Vecta group. Successful reperfusion without adjunctive therapy was achieved in 77.5% (69/89) in the Monopoint group compared to 50.6% (39/77) in the Vecta group (p<0.0001). SICH was similar between groups (3.6% vs. 2.7%, respectively).

Conclusion: In this randomized trial of patients with anterior large vessel occlusion, the large-bore Monopoint reperfusion system was non-inferior to the AXS Vecta aspiration catheter system in achieving successful reperfusion.

Disclosure of interest: T.Nguyen reports Associate Editor of Stroke; Advisory board of Brainomix, Aruna Bio; Speaker for Genentech, Kaneka; consulting for Medtronic. S.Hussain discloses consulting for Stryker Neurovascular.

02.00 - INTRACRANIAL HEMORRHAGE - 02.02 - SAH, ANEURYSMS AND VASCULAR MALFORMATIONS

O013 - ESOC2025-LB-560

MIDDLE MENINGEAL ARTERY EMBOLISATION FOR TREATMENT OF CHRONIC SUBDURAL HEMATOMA (cSDH) WITH TRUFILL n-BCA: MEMBRANE TRIAL PRIMARY RESULTS

Christopher P. Kellner¹, Ansaar Rai², Hazem Shoirah¹, Visish M. Srinivasan³, Rishi Gupta⁴, Robert Starke⁵, Fawaz Al-Mufti⁶, Charles Matouk⁷, Benjamin Yim⁸, Matthew Fusco⁹, Jieqing Wan¹⁰, Sohyun Boo², Brian Jankowitz¹¹

¹Mount Sinai Health System, New York, NY, United States, ²Radiology, West Virginia University, Morgantown, WV, United States, ³Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States, ⁴WellStar Health System, Marietta, GA, United States, ⁵University of Miami, Miami, FL, United States, ⁶Westchester Medical Center, Valhalla, NY, United States, ⁷Yale University, New Haven, NH, United States, ⁸John Muir Health, Walnut Creek, CA, United States, ⁹Vanderbilt University Medical Center, Nashville, TN, United States, ¹⁰Cerebrovascular Disease Center and Brain Injury Center, Renji Hospital, Shanghai, China, ¹¹JFK University Medical Center, Edison, NJ, United States

Background:Endovascular embolisation of the middle meningeal artery (eMMA) with a liquid embolic is an emerging treatment for cSDH. The prospective, global, multicentre, open-label MEMBRANE study (NCT04816591) evaluated the safety/effectiveness of TRUFILL n-Butyl Cyanoacrylate (n-BCA) for eMMA in participants with cSDH versus standard-of-care (SOC).

Case Report / Trial:Site physicians assessed participants for surgical or non-surgical management. After demonstrating cSDH stability, 376 participants were randomised to receive SOC alone or SOC and TRUFILL n-BCA eMMA in each surgical/non-surgical cohort, with follow-up at 1-, 3-, 6-, and 12-months post-procedure. The primary effectiveness endpoint was residual or re-accumulation of the cSDH (>10mm) at 6 months or re-operation or surgical procedure on the cSDH within 6 months. The primary safety endpoint was occurrence of all adverse events (AEs) through 6 months. The percentage of participants with good functional outcome at 3 months (modified Rankin Scale [mRS] 0-2 or no worsening from baseline if baseline mRS ⩾3) was assessed, along with other secondary endpoints.

High impact reason:This study demonstrates a positive treatment effect of eMMA using TRUFILL n-BCA versus SOC, with a safety profile that was comparable to SOC.

Results:Statistically significant treatment benefit of using TRUFILL n-BCA versus SOC across both cohorts (with or without surgery) was demonstrated (p=0.044). eMMA treatment was successfully non-inferior to SOC alone for assessment of good functional outcome. Overall AEs were reported by 71.8% and 65.3% of participants in the eMMA and SOC groups, respectively. Secondary effectiveness, safety, and health economic outcomes generally favoured eMMA treatment versus SOC alone.

Disclosure of interest: Christopher P. Kellner: Research at Mount Sinai supported by research grants from: Integra LifeSciences, Penumbra, Viz.ai, Siemens, Medtronic, Longeviti,IRRAS, iCE Neurosystems, CVAID, EndoStream, MicroTransponder; consultant for Route 92 Medical and Johnson & Johnson MedTech Neurovascular, with compensation to Mount Sinai for his time; and equity in Precision Recovery, Borealis, E8, Borvo, and METIS Innovative (METIS Innovative is an investment group that has coordinated investments in Synchron, Proprio, Fluid Biomed, VonVascular.io, Precision Recovery, Phantom Neuro, Radical, Aurenar, and Reach Neuro). Ansaar T. Rai: Consulting fees from Johnson & Johnson MedTech Neurovascular and Stryker. Hazem Shoirah: None. Visish M. Srinivasan: Consulting fees from Johnson & Johnson MedTech Neurovascular, Stryker, Imperative Care, IschemaView, and the National Football League. Grants from Zeiss, Medtronic, Stryker, and Siemens. Rishi Gupta: Steering committee for MEMBRANE study sponsored by Johnson & Johnson MedTech Neurovascular and ELEVATE study sponsored by Medtronic; principal investigator for DISTALS study sponsored by Rapid Medical, RECCLAIM II sponsored by ZOLL Medical, and ASSIST registry sponsored by Stryker Neurovascular; and Clinical Events Committee for MIND study sponsored by Penumbra. Robert M. Starke: Research supported by the Neurosurgery Research & Education Foundation, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000), and by National Institute of Health (R01NS111119-01A1 and UL1TR002736, KL2TR002737) through the Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities; unrestricted research grant from Medtronic and Balt Group; and consulting and teaching agreements with Penumbra, Abbott, Medtronic, Balt Group, InNeuroCo, Johnson & Johnson MedTech Neurovascular, Microvention, Stryker, Zylox-Tonbridge, VON Medical, and Optimize Vascular. Fawaz Al-Mufti: Consulting fees from Stryker Neurovascular, Johnson & Johnson MedTech Neurovascular, and Rapid AI. Charles Matouk: Consulting fee or speakers bureau for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical; research funding from NIH (Contact PI for NIH Grant R21NS128641). Benjamin Yim: Consulting fees from Kaneka, Imperative Care, Stryker, Q'Apel, Rapid Medical, and Penumbra. Site PI for KEEP (Kaneka), Citadel (Stryker), Imperative Trial (Imperative Care), and GRASP (Vivistim). Matthew Fusco: None. Jieqing Wan: None. SoHyun Boo: Consulting fee or speakers bureau for Stryker, Johnson & Johnson MedTech Neurovascular, and Microvention; proctor for the WEB™ device. Brian T. Jankowitz: Consultant for Johnson & Johnson MedTech Neurovascular, Rapid Medical, Medtronic, MIVI Neurosciences, Balt, Zimmer Biomet, Stryker, and IRRAS.

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 05.02 - SECONDARY PREVENTION

O014 - ESOC2025-LB-521

EFFICACY OF BLOOD PRESSURE CONTROL AMONG STROKE SURVIVORS OVER 12 MONTHS VIA A NURSE-NAVIGATOR, M-HEALTH-ENABLED INTERVENTION IN GHANA: A PHASE III MULTICENTER CLINICAL TRIAL

Fred Sarfo¹, Albert Akpalu², Ansumana Bockarie³, Nana Kwame Ayisi-Boateng¹, Rexford Adu Gyamfi⁴, Kwadwo Agyenim-Boateng⁵, Christiana Duah⁶, Timothy Fiattor⁷, Agnes Arthur⁸, Samuel Nguah¹, Bruce Obviagele⁹

¹Kwame Nkrumah University of Science & Technology, Kumasi, Ghana, ²University of Ghana Medical School, Accra, Ghana, ³University of Cape Coast, School of Medical Sciences, Cape Coast, Ghana, ⁴Agogo Presbyterian Hospital, Agogo, Ghana, ⁵Kwadaso SDA Hospital, Kumasi, Ghana, ⁶Kumasi South Hospital, Kumasi, Ghana, ⁷Manhyia District Hospital, Kumasi, Ghana, ⁸Ankaase Methodist Faith Hospital, Ankaase, Ghana, ⁹University of California, San Francisco, Kumasi, Ghana

Background: The overall objective of Phone-based Intervention under Nurse Guidance after Stroke II (PINGS-2) trial was to demonstrate the efficacy and safety of a mHealth technology-centered, nurse-led, multi-level integrated approach to substantially improve longer term BP control among recent stroke survivors.

Case Report / Trial: We enrolled 500 stroke survivors with uncontrolled blood pressure, within one month of symptom onset from 10 primary, district, and tertiary hospitals in Ghana. Eligible participants were allocated 1:1 to usual care or to the PINGS intervention comprising of domiciliary BP self-monitoring, use of phone alerts as medication reminders, m-health delivered audio messages with education on cardiovascular risk reduction over 12 months. Primary outcome was target BP < 140/ 90 mmHg at month 12.

High impact reason: Among stroke survivors in a low-income setting, a nurse-navigated, m-health enabled intervention sustainably controlled BP compared with usual care. Scaling up this intervention should be given policy consideration in Africa.

Results: Between July 2021 and June 2023, 500 eligible patients were randomly assigned to PINGS (n= 244) or usual care (n=256), 43% were females. 200(82%) participants in the PINGS arm vs 210(82%) in the usual care arm completed the study. At month 12, mean systolic BP in the PINGS was 138(20) mm Hg vs 143(22) mmHg, p<0.003; proportion meeting primary end point was 60% in the PINGS arm vs 41% in the usual care arm, p<0.001. There were 27/244(11.1%) vs 18/256(7.0%) serious adverse events in the PINGS vs usual care arms respectively, p=0.12. Funding: National Institutes of Health

Disclosure of interest: All authors: Nothing to disclose

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.01 - REHABILITATION

O015 - ESOC2025-LB-200

ENHANCEMENT OF STROKE REHABILITATION WITH LEVODOPA – THE ESTREL TRIAL

Stefan Engelter¹, Josefin E. Kaufmann¹, Sabine Schädelin², Andreas Luft³, René Müri⁴, Patrik Michel⁵, Jeremia Held⁶, Lars Hemkens⁷, Gary Ford⁸, Henrik Gensicke⁹, Christopher Tränka⁹, For the Estrel Investigators⁹

¹Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland, ²Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland, ³Department of Neurology, University and University Hospital of Zurich, Zurich, Switzerland, cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland, Zurich, Switzerland, ⁴Department of Neurology, University Hospital Inselspital, Bern, Switzerland, ⁵Stroke Center, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland, ⁶Neurocenter Bellevue, Department of Neurology, University and University Hospital of Zurich, Zurich, Switzerland, ⁷Department of Clinical Research, and Pragmatic Evidence Lab, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University Basel, Basel Switzerland, Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA, Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany, Basel, Switzerland, ⁸Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, United Kingdom, ⁹Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland

Background:Levodopa is used in stroke rehabilitation practice because of its potential to enhance motor recovery, but randomized evidence is uncertain.

Case Report / Trial:We conducted a double-blind, placebo-controlled, randomized controlled trial across 13 Swiss Stroke Units/Centers and 11 collaborating rehabilitation centers. Participants with clinically meaningful hemiparesis (i.e. ⩾3 points on motor arm/leg items of the National Institutes of Health Stroke Scale) following acute ischemic or hemorrhagic stroke were randomized 1:1 to receive levodopa/carbidopa (100 mg/25 mg) or placebo three times daily for 39 days alongside standardized rehabilitation therapy based on active task-oriented training. The primary outcome was the adjusted mean difference of the Fugl-Meyer Motor Assessment total score (FMMA; 0-100 points, fewer points indicate worse motor function) at three months.

High impact reason:ESTREL provides conclusive evidence on the use of levodopa to enhance stroke motor recovery.

Results:A total of 610 participants (242 female, 73 years median age; interquartile range [IQR] 64-82) underwent randomization (n=307 levodopa, n=303 placebo). Twenty-eight died, leaving 582 participants eligible for the primary analysis. At three months, participants in the levodopa group had a median FMMA total score of 68 points (IQR 42-85) compared to 64 points (IQR 44-83) in the placebo group. The mean difference in the FMMA total score between the levodopa and the placebo groups was -0.90 (95% CI, -3.78 to 1.98) points (p-value 0.54). Measures of harm were similar in groups. In conclusion, ESTREL provided no evidence to support the use of levodopa as an adjunct to rehabilitation therapy for enhancing motor recovery after acute stroke.

Disclosure of interest: SE, JK, SS, AL, RM, PM, JH, PL, LH, GF, HG, CT: Nothing to disclose regarding the content of the ESTREL trial. Funding: Swiss National Science Foundation (SNSF).

Closing Ceremony & Large Clinical Trials 2

09.00 - PRE-HOSPITAL SERVICE ORGANISATION - 09.01 - PRE-HOSPITAL SERVICE ORGANISATION

O016 - ESOC2025-LB-31

SAFETY AND EFFICACY OF TELEMEDICINE NEUROLOGIST ASSESSMENTS ON A MOBILE STROKE UNIT: A PROSPECTIVE, OPEN-LABEL, BLINDED END-POINT, RANDOMIZED CONTROLLED TRIAL (MSU-TELEMED)

Vignan Yogendrakumar^1,2, Anna Balabanski³, Hannah Johns⁴, Leonid Churilov⁴, Chloe Mutimer¹, James Barker¹, James Beharry⁵, Louise Weir¹, Nawaf Yassi⁴, Henry Zhao¹, Skye Coote¹, Bruce Campbell, Geoffrey A. Donnan¹, Stephen Davis¹

¹Royal Melbourne Hospital, Melbourne, Australia, ²The Ottawa Hospital, Ottawa, Canada, ³Alfred Health, Melbourne, Australia, ⁴University of Melbourne, Melbourne, Australia, ⁵Christchurch Hospital, Christchurch, New Zealand

Background: Mobile Stroke Units (MSUs) accelerate care, improving patient outcomes. Onboard and telemedicine neurologist models exist but have not been directly compared.

Case Report / Trial: MSU-TELEMED was a prospective, randomized, open-label, blinded-endpoint trial comparing conventional onboard neurologist care to a telemedicine care model in patients with suspected stroke. Enrolment was based on prospectively randomized days of onboard versus telemedicine. The primary outcome was the odds that patients in the telemedicine arm would have a better outcome than those in the onboard arm, using a hierarchical composite outcome evaluation, in order of importance: (1) safety; (2) scene-to-treatment-decision time; (3) resource utilization. All participants within each arm were compared to those in the other, resulting in a “win/tie/loss” distribution for telemedicine compared to onboard. A total sample size of 270 participants had 80% power to detect a win-odds of 1.5.

High impact reason: First RCT to show the superiority of a MSU telemedicine model using a novel hierarchical composite outcome assessment approach.

Results: In 275 participants enrolled and randomly assigned to telemedicine(n=135) or onboard(n=140), the primary outcome of win/tie/loss distribution overwhelmingly favoured telemedicine (76%/4%/21%) with a win-odds of 3.57(95%CI:2.4-5.2, p<0.0001) (Figure 1). Safety events did not differ (12% telemedicine vs 11% onboard, risk-ratio:0.99, 95%CI:0.49-2.03). Median scene-to-treatment-decision time in the telemedicine arm was 4 minutes longer, however resource utilization was significantly lower in the telemedicine arm. Among patients who received thrombolysis or were transported by the MSU for endovascular therapy(18%), no difference in 90-day ordinal mRS shift between treatment arms was observed.

Disclosure of interest: Vignan Yogendrakumar: nothing to disclose

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

O017 - ESOC2025-LB-181

BRIDGE TNK: A RANDOMIZED TRIAL OF INTRAVENOUS TENECTEPLASE PLUS ENDOVASCULAR THROMBECTOMY VERSUS ENDOVASCULAR THROMBECTOMY ALONE FOR ACUTE ISCHEMIC STROKE

Zhongming Qiu¹, Fengli Li¹, Dongjing Xie¹, Guangxiong Yuan², Thanh N. Nguyen, Raul Nogueira³, Jeffrey Saver⁴, Bruce Campbell⁵, Greg Albers⁶, Hongfei Sang⁷, Duolao Wang⁸, Wenjie Zi¹, Qingwu Yang¹

¹Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China, ²Xiangtan Central Hospital, Xiangtan, China, ³University of Pittsburgh School of Medicine, PA, United States, ⁴David Geffen School of Medicine at UCLA, CA, United States, ⁵Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, VC, Australia, ⁶Stanford Stroke Center, Stanford University, CA, United States, ⁷Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China, ⁸Liverpool School of Tropical Medicine, Liverpool, United Kingdom

Background: Six randomized trials have not detected a difference between intravenous alteplase plus endovascular thrombectomy and endovascular thrombectomy alone in stroke. Tenecteplase (TNK), a recombinant human TNK tissue-type plasminogen activator (rhTNK-tPA), is a genetically modified variant of alteplase. It is unclear whether the outcomes are different if alteplase is replaced with tenecteplase. This trial aims to determine whether intravenous tenecteplase within 4.5 hours of time last known well confers benefit in acute ischemic stroke patients with large vessel occlusion who undergo endovascular thrombectomy.

Case Report / Trial: Thrombectomy With Versus Without rhTNK-tPA in Stroke (BRIDGE TNK) was an investigator-initiated, multicenter, prospective, randomized, open-label trial with blinded endpoint evaluation conducted at 39 thrombectomy-capable centers in China. This trial randomized 544 intravenous thrombolysis-eligible stroke patients (272 in each arm) with large vessel occlusion within 4.5 hours of last known well to receive bridging intravenous tenecteplase with endovascular thrombectomy or endovascular thrombectomy alone. The primary outcome was the proportion of patients achieving functional independence, defined as a score of 0-2 on the modified Rankin scale, at 90 days. Safety was assessed via symptomatic intracranial hemorrhage at 48 hours and mortality at 90 days.

High impact reason:

BRIDGE TNK will provide important data on the role of intravenous tenecteplase prior to endovascular thrombectomy in acute ischemic stroke patients with large vessel occlusion who can be treated within 4.5 hours of last known well.

Results: BRIDGE TNK randomized 554 patients between May 9, 2022, and September 8, 2024. We expect that the statistical results will be completed in February 2025.

Disclosure of interest: Zhongming Qiu: nothing to disclose. Fengli Li: nothing to disclose. Dongjing Xie: nothing to disclose. Guangxiong Yuan: nothing to disclose. Thanh N. Nguyen: discloses advisory board for Aruna Bio, Brainomix; Associate Editor of Stroke. Raul G. Nogueira: nothing to disclose. Jeffrey L. Saver: nothing to disclose. Bruce C. V. Campbell: nothing to disclose. Gregory W. Albers: nothing to disclose. Hongfei Sang: nothing to disclose. Duolao Wang: nothing to disclose. Wenjie Zi: nothing to disclose. Qingwu Yang: nothing to disclose.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.03 - HYPERACUTE MANAGEMENT

O018 - ESOC2025-LB-533

INDIVIDUALIZED VERSUS STANDARD BLOOD PRESSURE CONTROL DURING MECHANICAL THROMBECTOMY FOR ANTERIOR ACUTE ISCHEMIC STROKE: THE DETERMINE RANDOMIZED CLINICAL TRIAL

Benjamin Maïer¹, Benjamin Gory², Russell Chabanne³, Benoit Tavernier⁴, Vincent Degos⁵, Baptiste Balanca⁶, Maxime Pommier⁷, Morgan Le Guen⁸, Laurie-Anne Thion⁹, Bertrand Lapergue¹⁰, Jean-Marc Olivot⁷, Michel Piotin⁹, Le Cossec Chloé⁹, Mikael Mazighi¹¹, Etienne Gayat¹²

¹Hôpital Fondation A. de Rothschild, Paris, France, Hôpital Paris Saint-Joseph, Paris, France, Université Paris-Cité, Paris, France, ²CHRU Nancy, Nancy, France, ³CHRU Clermont-Ferrand, Clermont-Ferrand, France, ⁴CHRU Lille, Lille, France, ⁵Hôpital Pitié-Salpêtrière, Paris, France, ⁶CHRU Lyon, Lyon, France, ⁷CHRU Toulouse, Toulouse, France, ⁸Hôpital Foch, Suresnes, France, ⁹Hôpital Fondation A. de Rothschild, Paris, France, ¹⁰Foch Hospital, Suresnes, France, ¹¹Hôpital Fondation A. de Rothshchild, Paris, France, ¹²Hôpital Lariboisière, Paris, France

Background: Current recommended blood pressure (BP) targets during mechanical thrombectomy (MT) rely on a one-size fits all approach aiming at preventing hypertension. Given the potential deleterious effect of hypotension during MT, we aimed to assess the effectiveness and safety of an individualized BP management during MT, adapted to the patient’s physiology, compared with a standard BP management.

Case Report / Trial: The DETERMINE Randomized Clinical Trial, ClinicalTrials.gov, number NCT04352296 (terminated)

High impact reason: We conducted a multicentre, open-label, blinded-endpoint, randomised controlled trial at 8 academic comprehensive stroke centres in France. Adults (⩾18 years old) with an acute ischemic stroke due to an anterior large vessel occlusion and an indication for MT were eligible. Patients were randomly assigned (1:1) to an individualized blood pressure management during MT (where the mean arterial pressure -MAP- was maintained within 10% of the first MAP measured before MT) or a control group (systolic blood pressure maintained within 140 and 185 mm Hg), using a Web-based randomization system with a minimization algorithm. The primary outcome was favorable functional outcome, defined as a modified Rankin Scale score between 0 and 2 at 90 days in the intention-to-treat population. Safety outcomes included mortality at 90 days and symptomatic intracranial hemorrhages. DETERMINE is the first multicentre randomized clinical trial evaluating an individualized blood pressure management during MT.

Results: Primary and secondary results will be presented at the ESOC 2025.

Disclosure of interest: The DETERMINE trial was funded by the French Health Ministry.

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.02 - ACUTE MANAGEMENT - Thrombolysis or thrombectomy

O019 - ESOC2025-LB-176

EMERGENT CAROTID STENTING IN TANDEM OCCLUSIONS OF ANTERIOR CIRCULATION: THE MULTICENTER CERES-TANDEM STUDY

Michele Romoli¹, Jessica Jesser², Elena Zapata Arriaza³, Mirjam Rachel Heldner⁴, Diana Aguiar de Sousa⁵, Giovanni Merlino⁶, Francesco Arba⁷, Fabrizio Giammello⁸, Adnan Siddiqui⁹, Razvan Alexandru Radu¹⁰, Lucio D'anna¹¹, Uta Hanning¹², Andrea Zini¹³, Thanh N. Nguyen¹⁴, Francesco Diana¹⁵

¹Department of Neurosciences, Bufalini Hospital, Cesena, Italy, Cesena, Italy, ²University of Heidelberg, Heidelberg, Germany, ³Interventional Neuroradiology Department, Virgen de Rocio University Hospital, Seville, Spain, ⁴Inselspital Bern, Bern, Switzerland, ⁵University of Lisbon, Lisboa, Portugal, ⁶University of Udine, Udine, Italy, ⁷Stroke Unit, AOU Careggi, Firenze, Italy, ⁸University of Messina, Messina, Italy, ⁹University of Buffalo, Buffalo, United States, ¹⁰University of Montpellier, Montpellier, France, ¹¹Imperial College London, London, United Kingdom, ¹²Hamburg University, Hamburg, Germany, ¹³IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy, ¹⁴Boston Medical Center, Boston, United States, Boston, United States, ¹⁵Vall d'Hebron Hospital, Barcelona, Spain

Background: The multicenter CERES-TANDEM study aimed at defining the impact of emergent carotid stenting (eCAS) in anterior circulation tandem occlusion stroke.

Case Report / Trial: We included consecutive patients undergoing endovascular thrombectomy for acute anterior circulation ischemic stroke due to tandem occlusion, prospectively enrolled in local registries from 2018 to 2024 at 48 large volume stroke centers across 3 continents. The protocol was approved by the two proposing Centers (Bufalini Hospital Stroke Hub, Italy, and Vall d’Hebron Research Institute, Barcelona, Spain). Data regarding the endovascular procedure, emergent or delayed stenting, antithrombotic regimen and clinical and neuroradiological outcomes were collected. The primary outcome was mRS 0-2 at 3 months. Additional outcomes were procedural complications, symptomatic intracranial hemorrhage (ECASSII), and 24h NIHSS. We used adjusted logistic regression with inverse probability of treatment weighting (IPTW) to determine associations between eCAS and study outcomes, considering demographic features, stroke severity, ASPECTS, ischemic core and vessel anatomy data.

High impact reason: As the management of acute ischemic stroke due to tandem occlusion is controversial, this large multicentre study can provide relevant information regarding the impact of eCAS on functional outcomes.

Results: The study included 4085 patients (2403 eCAS vs 1682 no eCAS), mean age 69 years, 34.2% female. Stroke severity, baseline ASPECTS, ischemic core (rCBF30%) and onset to groin timing were similar between the eCAS and no eCAS groups. In adjusted logistic regression with IPTW (eCAS vs no eCAS), eCAS was associated with a higher rate of good functional outcome (Odds Ratio=1.49, 95%CI=1.27-1.73, p<0.001), despite a relative increase in sICH (OR=1.27, 95%CI=1.01-1.60, p=0.047).

Disclosure of interest: None.

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.03 - PROGNOSIS AND OUTCOME AFTER STROKE

O020 - ESOC2025-LB-264

HARMONICS: A HOLISTIC VALUE-BASED CARE HYBRID PROGRAM THAT MAXIMIZES CLINICAL OUTCOMES AFTER STROKE

Marta Rubiera¹, Marián Muchada¹, Giorgio Colangelo², João Sargento Freitas³, Xavier Ustrell Roig⁴, Francisco Purroy⁵, Yolanda Silva⁶, Alejandro Bustamante⁷, Cristina Guirao², Sara Bernardo-Castro³, Noelia Canela⁴, Laura Bartra⁵, Elisabet Ortiz Martos⁶, Marc Ribo¹, Carlos A. Molina¹

¹Hospital Universitari Vall d'Hebron, Barcelona, Spain, ²Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain, ³Hospitais da Universidade de Coimbra, Coimbra, Portugal, ⁴Hospital U. Joan XXIII, Tarragona, Spain, ⁵Hospital Universitari Arnau de Vilanova, Lleida, Spain, ⁶Hospital Universitari Dr. Josep Trueta, Girona, Spain, ⁷Hospital U. Germans Trias i Pujol, Badalona, Spain

Background: There is an increasing prevalence of stroke survivors who require post-hospitalization healthcare and social support. Harmonization of processes and collection of clinician and patient-reported outcomes (CROMS/PROMS) is crucial. We aimed to develop HARMONICS, a holistic solution to provide value-based care and improve outcomes after hospitalization in stroke patients.

Case Report / Trial: A holistic plan based on Lean methodology was designed and implemented in 6 international comprehensive stroke centers. Consecutive patients were offered to participate in the HARMONICS solution: continuous follow-up during 1year after post-stroke hospitalization through a technological bi-directional patients/caregivers and expert healthcare professional communication smartphone-based tool. Predefined automatic repeated data collection of health vitals and PROMS, real-time data analytics and monitoring through an interactive interface was performed (see Figure 1). Key performance indicators (KPI), patients’ experience and outcomes pre- and post-implantation were evaluated.

High impact reason: The implantation of a holistic value-based protocol after hospitalization in stroke patients is feasible and may lead to improvement in CROMS and PROMS. If confirmed, an escalation plan is warranted.

Results: Along 3 years of recruitment, 6610 patients were evaluated for the HARMONICS protocol, from which 4377 were included in the study (Figure 2). Baseline clinical characteristics, stroke subtypes, outcomes and KPI are shown in Figure 3. The median degree of satisfaction with the HARMONICS follow-up was 9 (IQR 8-10) and there was frequent communication between patients and healthcare professionals (median 11 chats/patient). Higher PROMs rate of collection and better outcomes than our historic cohort were detected.

Disclosure of interest: EITHealth. European Commission Funding

Figure 1 Figure 2 Figure 3

03.00 - RECOVERY, REHABILITATION AND OUTCOME - 03.01 - REHABILITATION

O021 - ESOC2025-LB-189

EFFECTIVENESS OF A HOME-BASED, TAILORED INTERVENTION FOR REDUCING FALLS AFTER STROKE (FAST): A PROSPECTIVE, BLINDED ASSESSOR, CONCEALLED ALLOCATION RANDOMIZED CONTROLLED TRIAL

Katharine Scrivener¹, Catherine Dean¹, Natasha Anne Lannin^2,3, Louise Ada⁴, Sally Day⁴, Stephen Isbel⁵, Elisabeth Preston⁵, Gillian Heller⁴, Virginia Mumford¹, Lindy Clemson⁴

¹Macquarie University, Sydney, Australia, ²Monash University, Melbourne, Australia, ³Alfred Health, Melbourne, Australia, ⁴University of Sydney, Sydney, Australia, ⁵University of Canberra, Canberra, Australia

Background: After stroke, adults are more prone to falls than the general population, often resulting in fall-related injuries such as fractures and increased hospital admissions. We hypothesize that a home-based falls program delivered by physical and occupational therapists will reduce falls compared to usual care.

Case Report / Trial: The FAST trial is a multistate, Phase III randomized trial with concealed allocation, blinded assessment, and intention-to-treat analysis. We compare usual care controls to an experimental group who receive habit-forming exercise, home safety and community mobility training program tailored to walking speed (slow <0.4m/s, medium 0.4-0.8m/s, fast >0.8m/s). Ambulatory stroke survivors within five years of stroke who had been discharged to the community were randomly allocated 1:1 to receive the experimental or control intervention. The primary outcome is the rate of falls over 12 months; secondary outcomes included community participation, physical activity, and health-related quality of life. A sample size of 370 participants is powered at 80% to detect a clinically important between-group difference of a 30% lower rate of falls.

High impact reason: Definitive randomized clinical trial which will directly provide first-in-world evidence for clinical practice guidelines.

Results: Trial was complete in December 2024 (370 participants enrolled; female 46%, mean age 76 years, median time after stroke recruited 28 months). Results will be available for the European Stroke Organization Conference in Helsinki, Finland. Our results will identify an effective intervention to prevent falls in adults living with stroke, and these will be used to optimize post-stroke rehabilitation in the community.

Disclosure of interest: FAST is funded by the National Health and Medical Research Council (Australia);Katharine Scrivener: nothing to disclose; Catherine Dean nothing to disclose; Natasha A. Lannin: fellowship funded by the Heart Foundation (Australia); Louise Ada: nothing to disclose; Sally Day: nothing to disclose; Stephen Isbel: nothing to disclose; Elisabeth Preston: nothing to disclose; Anne Cusick: nothing to disclose; Gillian Heller: nothing to disclose; Virginia Mumford: nothing to disclose; Lindy Clemson: nothing to disclose;

01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.01 - ACUTE MANAGEMENT - Neither thrombolysis nor thrombectomy

O022 - ESOC2025-LB-93

EARLY VERSUS DELAYED ANTICOAGULATION IN ACUTE ISCHAEMIC STROKE ACCORDING TO INFARCT VOLUME, LOCATION AND HAEMORRHAGIC TRANSFORMATION: A PRE-SPECIFIED ANALYSIS OF THE OPTIMAS RANDOMISED CONTROLLED TRIAL

Philip Nash¹, Jonathan Best¹, James Lyon¹, James Ruffle², Thanyalak Amornpojnimman¹, Rom Mendel¹, Chris Foulon², Hakim-Moulay Dehbi³, Norin Ahmed³, Sue Massingham³, Tishok Vanniyasingam³, Nicholas Freemantle³, Parashkev Nachev², David Doig^1,4, David Werring¹

¹Stroke Research Centre, UCL Queen Square Institute of Neurology, Department of Neuroradiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom, ²UCL Queen Square Institute of Neurology, London, United Kingdom, ³Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom, ⁴Department of Neuroradiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom

Background: The effects of early anticoagulation after acute ischaemic stroke (IS) according to infarct volume, location or haemorrhagic transformation (HT) are uncertain.

Case Report / Trial: OPTIMAS was a randomised, parallel-group, open-label trial with blinded outcome assessment. Participants with IS and atrial fibrillation were randomised 1:1 to early (⩽4 days) or delayed (at day 7-14) DOAC initiation. The primary outcome was a composite of recurrent IS, symptomatic intracranial haemorrhage and systemic arterial embolism. When available, we determined infarct volume using diffusion-weighted MR using a validated deep learning segmentation model. For those with CT we segmented infarcts manually with semi-automated tools. We classified the population according to infarct volume tertiles and arterial territory. We fitted interaction terms of subgroups with treatment allocation in mixed effects logistic regression models.

High impact reason: We found no heterogeneity of the treatment effect of early anticoagulation according to infarct volume or HT, providing reassurance that these infarct features should not preclude DOAC initiation within 4 days of acute IS.

Results: 3572 participants (mean age 78.0±9.9, 45.4.% female, 98.6% of the main trial population, Tables 1&2) were included. There was no significant difference in treatment effect on the primary outcome across infarct volume tertiles. The ORs (95% CIs) were 1.27 (0.61-2.64), 1.02 (0.49-2.10) and 0.81 (0.47-1.39) for the lowest, middle and highest infarct volume tertiles respectively, p_interaction=0.619 (Fig. 1). There was no significant difference of the intervention treatment effect according to HT presence (OR 1.37 [0.47-3.95]) or absence (OR 0.96 [0.64-1.43]), p_interaction=0.541, or according to arterial territory (anterior vs posterior circulation).

Disclosure of interest: This research was funded by the British Heart Foundation. None of the authors have anything to disclose in relation to this work.

05.00 - RISK FACTORS AND PREVENTION (PRIMARY AND SECONDARY) - 05.02 - SECONDARY PREVENTION

O023 - ESOC2025-LB-584

ASSOCIATION OF INFARCT VOLUME AND OUTCOME FOLLOWING EARLY ANTICOAGULATION IN THE ELAN TRIAL – POST-HOC ANALYSIS

Martina Goeldlin¹, Arsany Hakim², Jean-Benoit Rossel³, Louanne Béraud^1,2, Nico Blumer^1,2, Roman Rohner², Richard McKinley², Stefanie Abend¹, Thomas Horvath¹, Masatoshi Koga⁴, Daniel Strbian⁵, Adhiyaman Vedamurthy⁶, Manju Krishnan⁷, Jesse Dawson⁸, Urs Fischer¹

¹Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland, ²University Institute for Diagnostic and Interventional Neuroradiology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland, ³Clinical Trials Unit, University of Bern, Bern, Switzerland, ⁴Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan, ⁵Department of Neurology, Helsinki University Hospital, Helsinki, Finland, ⁶Glan Clwyd Hospital, Betsi Cadwaladr University Local Health Board, Rhyl, United Kingdom, ⁷Stroke Unit, Morriston Hospital, Swansea Bay University Health Board, Swansea, United Kingdom, ⁸School of Cardiovascular and Metabolic Health, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, United Kingdom

Background:The randomized-controlled ELAN trial reported the rate of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial hemorrhage, or vascular death following early (< 48h in minor and moderate, 6-7 days in major stroke) or late (3-4 days in minor, 6-7 days in moderate, 12-14 days in major stroke) initiation of direct oral anticoagulants in people with atrial fibrillation and ischaemic stroke. Early initiation was associated with net clinical benefit. We assessed whether the infarct volume modifies the risk of recurrent vascular events and bleeding complications in people with ischaemic stroke and atrial fibrillation.

Case Report / Trial: In this post-hoc analysis of data from the ELAN trial, we will include all participants who had an MRI scan of the head of sufficient quality before randomization. The primary outcome is a composite of recurrent ischemic stroke, systemic embolism, major extracranial bleeding, symptomatic intracranial haemorrhage or vascular death within 30 days. Infarct volume (in mL) will be determined by semi-automated volumetry based on diffusion-weighted imaging. We will assess the association of infarct volume with the primary outcome using penalized logistic regressions, adjusting for pre-specified confounders, including treatment timepoint, infarct location and multi-territory infarcts.

High impact reason: This post-hoc analysis from the large, randomized-controlled ELAN trial will inform us whether infarct volume should be considered when determining the ideal timepoint to initiate DOACs in persons with ischaemic stroke and atrial fibrillation.

Results: 829 participants had at least one MRI head before randomization. Volumetric analysis of MRI scans are still ongoing. Final results will be presented at ESOC 2025.

Disclosure of interest: Dr Goeldlin reported receiving grants from Bangerter-Rhyner-Foundation/Swiss Academy of Medical Sciences during the conduct of the study; receiving grants from Bangerter-Rhyner-Foundation/Swiss Academy of Medical Sciences, Insel Gruppe AG, European Stroke Organisation Department, and Mittelbauvereinigung Universität Bern Networking outside the submitted work; and receiving congressional bursary from the European Academy of Neurology. Dr Dawson reported receiving grants from the Stroke Association during the conduct of the study. Dr Fischer reported receiving grants from the Swiss National Science Foundation and the Swiss Heart Foundation during the conduct of the study; receiving grants from Medtronic, Stryker, Phenox, Penumbra, RapidMedical, and Boehringer Ingelheim outside the submitted work; receiving consultancy fees paid to his institution from Medtronic; participating in the advisory board for AstraZeneca (former Alexion/Portola), Bayer, Boehringer Ingelheim, Biogen, AbbVie, Siemens (fees paid to his institution); serving as a member of a clinical event committee for Phenox and of the data and safety monitoring committee of the TITAN, LATE_MT, IN EXTREMIS and RapidPulse trials; and serving as president of the Swiss Neurological Society and president-elect of the European Stroke Organisation.

02.00 - INTRACRANIAL HEMORRHAGE - 02.01 - INTRACEREBRAL HAEMORRHAGE

O024 - ESOC2025-LB-97

COLCHICINE FOR THE PREVENTION OF VASCULAR EVENTS AFTER AN ACUTE INTRACEREBRAL HEMORRHAGE (COVASC-ICH)

Aristeidis Katsanos¹, Kelvin Ng¹, Thalia Field², Aravind Ganesh³, Joanna Schaafsma⁴, Shirin Jalini⁵, Ashfaq Shuaib⁶, Lauren Mai⁷, Amy Yu⁸, Laura Gioia⁹, Regan Cooley¹⁰, Dar Dowlatshahi¹¹, Angela Wang¹, Kumar Balasubramanian¹, Ashkan Shoamanesh¹

¹McMaster University/ Population Health Research Institute, Hamilton, Canada, ²University of British Columbia, Vancouver, Canada, ³University of Calgary, Calgary, Canada, ⁴University of Toronto/ University Health Network, Toronto, Canada, ⁵Queen's University, Kingston, Canada, ⁶University of Alberta, Edmonton, Canada, ⁷Western University, London, Canada, ⁸University of Toronto/ Sunnybrook Research Institute, Toronto, Canada, ⁹Centre hospitalier de l'Université de Montréal, Montreal, Canada, ¹⁰University of Saskatchewan, Saskatoon, Canada, ¹¹University of Ottawa, Ottawa, Canada

Background: Intracerebral hemorrhage (ICH) survivors are at high risk of ischemic vascular events. Colchicine may reduce the risk of major adverse cardiovascular events (MACE) without increasing the bleeding risk.

Case Report / Trial: CoVasc-ICH (NCT05159219) is a randomised, double-blind, placebo-controlled trial evaluating the feasibility of conducting a main phase trial. Adults within 48 hours of spontaneous ICH onset, with atherosclerotic risk factors or established atherosclerosis, were randomly assigned (1:1) to either oral colchicine 0.5mg once daily or matching placebo. The primary efficacy outcome collected in anticipation of a main phase trial is MACE during follow-up. Secondary efficacy endpoints include the modified Rankin Scale (mRS) at 6 months.

High impact reason: CoVasc-ICH is the first randomized trial testing colchicine in patients with acute ICH.

Results: We enrolled 100 participants (mean age 68 years, 41% females) at 11 Canadian stroke centres between August 2022 and March 2024 (average recruitment rate: 8.7 participants/site/year). Six out of 52 participants allocated to colchicine (11.5%) and five out of 48 participants allocated to placebo (10.4%) experienced a MACE during a median follow-up of 337 days (HR=1.22, 95%CI: 0.37-4.01). No difference in the distribution of mRS scores at 6 months was noticed (common OR=1.24, 95%CI: 0.59- 2.59). Any stroke occured in 2 patients, both recurrent ICH, assigned to placebo (4.2%). Symptomatic hematoma expansion occurred in 1 patient receiving colchicine (1.9%). Any serious adverse event occured in 8 participants in the colchicine arm and 3 participants in the control arm (15.4% vs. 6.3%, p=0.145).

Disclosure of interest: Funded by the Canadian Institutes of Health Research and the Population Health Research Institute.