Abstract Number: Esoc2026a1637 the Value of Intravenous Thrombolysis for Patients With Suspected Lacunar Stroke: An International Survey Study

Abstract Background and aims Intravenous thrombolysis (IVT) is the approved treatment for all ischemic stroke subtypes; however, its effectiveness in lacunar stroke remains uncertain. To explore this, we conducted an international survey to assess clinician perspectives on the management of suspected lacunar stroke. We examined treatment preferences across clinical scenarios, attitudes toward IVT and dual antiplatelet therapy (DAPT), and support for future randomized trials comparing these approaches. Methods We conducted a cross-sectional international survey with scenario-based questions and Likert-scale responses using REDCap. Descriptive statistics were used to analyze treatment preferences across subgroups. Results A total of 393 physicians participated, including 61.1% vascular neurologists and 38.9% non-stroke specialists. IVT was the preferred treatment across all scenarios (67.9%), with no major differences observed between specialties or between comprehensive stroke centers and other settings. DAPT was most frequently considered (40.7%) in a scenario involving a 61-year-old patient with vascular risk factors and a lacunar stroke presenting as sensorimotor hemiparesis predominantly affecting the right leg (National Institutes of Health Stroke Scale NIHSS 3); 74.9% of respondents felt this case was not well represented in current IVT guidelines. Willingness to enroll similar patients in a randomized trial comparing DAPT and IVT was high, ranging from 88.8% in the low NIHSS case to 79.5% in a more severe presentation (NIHSS 7) involving dementia and leukoencephalopathy. Conclusions Clinician preferences varied across lacunar stroke scenarios, particularly in lower NIHSS presentations, indicating clinical equipoise. These findings underscore the need for a randomized controlled trial comparing DAPT and IVT in patients with suspected lacunar stroke. Conflict of interest Jessika Gorzolka. nothing to disclose. Chantal Kaempf. nothing to disclose. Simona Sacco. nothing to disclose. Hui-Sheng Chen. nothing to disclose. Urs Fischer. nothing to disclose. Bruce Campbell. nothing to disclose. Diana Aguiar de Sousa. nothing to disclose. Volker Puetz. nothing to disclose. Goetz Thomalla. nothing to disclose. Bastian Cheng. nothing to disclose. Charlotte Cordonnier. nothing to disclose. Grégoire Boulouis. nothing to disclose. Espen Kristoffersen. nothing to disclose. Michael Hill. nothing to disclose. Luciano Sposato. nothing to disclose. Mai Duy Ton. nothing to disclose. Hiroshi Yamagami. nothing to disclose. Wei Hu. nothing to disclose. Mira Katan. nothing to disclose. Thanh N. Nguyen. nothing to disclose. Joachim Fladt. nothing to disclose.