Abstract Number: Esoc2026a779 Endovascular Treatment of Stroke Patients on Dual Antiplatelet Therapy in Clinical Practice: A Multicentre Analysis of the German Stroke Registry

Abstract Background and aims Stroke is a major global health burden and a leading cause of adult disability. Endovascular therapy (EVT) significantly improves outcome and survival in patients with large vessel occlusion strokes. However, many stroke patients have pre-existing cardiovascular disease requiring antiplatelet therapy, including dual antiplatelet therapy (DAPT). While DAPT is well established for secondary stroke prevention, its impact on EVT remains uncertain. Methods We analysed data from a prospective multicentre EVT-cohort, the German Stroke Registry. We examined baseline characteristics, haemorrhagic complications, and functional outcome of patients on pre-stroke DAPT undergoing EVT. The average treatment effect of DAPT was double-robust estimated using propensity score weighting with outcome regression analysis. Results Among 13,082 patients, 312 (2.38%) underwent EVT on pre-stroke DAPT (median age 74 years IQR 66.5–82, 43.2% female). Median pre-admission mRS was 1 (IQR 0–2), median admission NIHSS score was 15 (IQR 8–19), and successful reperfusion (mTICI ≥2b) was achieved in 83.2%. Any intracranial haemorrhage (ICH) occurred in 23.0%. Median 90-day mRS was 4 (IQR 2–6). DAPT was not associated with significant differences in functional outcome or survival, but was associated with an approximately threefold increased risk of ICH compared to both single APT and to no APT. Updated analyses will be presented at the meeting. Conclusions Pre-stroke DAPT was associated with a higher rate of any ICH after EVT but did not adversely affect functional outcome or survival. EVT appears to be effective in patients on DAPT despite increased haemorrhagic risk. Conflict of interest The authors report no conflicts of interest related to this project.