Abstract Number: Esoc2026a2252 Thrombectomy Outcomes of Large Artery Atherosclerosis-Related Occlusions in Patients With Large-Core Ischemic Stroke

Abstract Background and aims Large artery atherosclerosis (LAA) is a major cause of large vessel occlusion (LVO) stroke and presents unique challenges for endovascular therapy, particularly in patients with large-core infarcts. This study evaluated the clinical characteristics and thrombectomy outcomes in large-core ischemic stroke due to LAA compared with other etiologies. Methods We retrospectively analyzed data from a prospective, multicenter cohort study of patients with large-core ischemic stroke (ASPECTS ≤5) due to anterior circulation LVO within 24 hours of onset (July 2023–September 2024). Baseline demographics and outcomes were compared between LAA and non-LAA groups. Favorable functional outcome was defined as an mRS score ≤3 at 90 days. Results Among 404 patients, 120 had LAA and 284 non-LAA. The LAA group had higher prevalence of male sex (79.2% vs 57.4%, p0.001) and smoking (p0.001), but less atrial fibrillation (p0.001). No significant differences were observed in age (62 vs 64 years, p=0.171) or baseline NIHSS (17.0 vs 18.0, p=0.118). Successful recanalization (mTICI 2b/3) was achieved in 90% of LAA cases. LAA patients required more rescue balloon angioplasty (55.5% vs 5.3%, p0.001), rescue stenting (4.2% vs 0%, p0.001), and had longer onset-to-reperfusion time (10.1 vs 9.5 h, p=0.038). However, the LAA group demonstrated similar favorable outcomes (p=0.07) and lower mortality (5.5% vs 19.3%, p=0.001). Symptomatic intracranial hemorrhage rates were comparable (4.5% vs 8.3%, p=0.25). Conclusions Endovascular therapy for large-core stroke due to LAA is technically challenging but achieves high reperfusion and favorable outcomes when rescue strategies are employed, resulting in outcomes comparable to non-LAA cases. Conflict of interest Hang Tran: nothing to disclose, Trung Quoc Nguyen: nothing to disclose, Khang Vinh Nguyen: nothing to disclose, Thang Huy Nguyen: nothing to disclose