Abstract Number: Esoc2026ys121 Does Angiographic Strategy Matter? Influence of Stroke Etiology on First-Pass Reperfusion and Early Neurological Recovery in a Real-World Acute Stroke Cohort

Abstract Background and aims Achieving first-pass reperfusion (FPR) during mechanical thrombectomy is associated with improved procedural efficiency and early neurological recovery. However, acute ischemic stroke patients encountered in routine clinical practice are highly heterogeneous with respect to age, vascular territory, and stroke etiology. The extent to which the underlying stroke mechanism modifies the relationship between the initially selected angiographic strategy and early clinical outcomes remains insufficiently defined. We aimed to evaluate the influence of stroke etiology on FPR and early neurological recovery according to the initially selected reperfusion strategy. Methods This retrospective observational study analyzed consecutive acute ischemic stroke patients who underwent emergency cerebral angiography at a single comprehensive stroke center over a 6-month period. Patients with anterior circulation large vessel occlusion treated with intravenous thrombolysis and/or endovascular therapy were included. Baseline demographics, admission NIHSS, non-contrast CT ASPECTS, occlusion site, and stroke etiology according to TOAST classification were extracted. First-pass strategies were categorized as aspiration-based techniques, combined techniques or intravenous thrombolysis alone. FPR was defined as achieving mTICI ≥2b with a single device pass. Early neurological outcome was assessed using 24-hour NIHSS change. Results Within the clinically favorable subgroup,combined endovascular techniques were most frequently used (66.7%). FPR and greater early NIHSS improvement were more commonly observed in cardioembolic strokes, whereas large artery atherosclerotic and tandem lesions required more passes and showed less pronounced recovery. Procedural complications occurred in 7.4% of patients. These real-world findings suggest that stroke etiology is a key determinant of procedural complexity, FPR success, and early neurological recovery. Conflict of interest Elif Doğa Ulugöl : nothing to disclose