Abstract Number: Esoc2026a2506 Real World Experience of Acute Interventions in Large Core Strokes: A Single Center Study From a North Indian Stroke Center

Abstract Background and aims Large core strokes (50 mL) usually have poor outcomes. Thrombectomy trials although have shown improved functional outcomes, most did not include patients from LMICs. Real world data from LMICs in this subset of acute ischemic strokes(AIS) is limited. We aim to describe real world outcomes of intervention in large core strokes. Methods Data of AIS patients in our stroke registry from February2022-November2025, presenting within 24 hours with large core (50 ml) or low ASPECTS (2-5) were included. Data included comorbidities, imaging, reperfusion therapy (IV thrombolysis (IVT) or mechanical thrombectomy, bridging), and outcomes (NIHSS at baseline and 48 hours, modified Rankin Scale mRS, and mortality at 3 months). Results Out of 1066 AIS , 45 (4.22%) fulfilled Inclusion/ Exclusion criteria. Mean age was 54.56 ± 15.23 years, 77.78% male. 53.3% had hypertension. 91.1% had anterior circulation strokes. Baseline median ASPECTS was 5 4-5. IV Thrombolysis was done in 29 (64.4%) and thrombectomy in 16 (35.6%). Median door-to-CT and door-to-needle times were 15 10-18 and 41 32-60 minutes. NIHSS was14 9-18 at baseline ,12 7-18 at 48 hours and 6 3-10 at 3 months. 1 month Median mRS was 4 3-4 and 3 months was 3 2-4;13 (28.9%) had mRS 0-2. 11(69%) achieved TICI 2b/3 grade.13 (28.9%) died, mostly secondary to haemorrhagic conversion (6/13, 46.2%). Conclusions Acute interventions (IVT/MT)in large core strokes in real world settings is feasible and efficacious in LMICs. Carefully selected patients for reperfusion therapies in large-core strokes may be associated with good outcomes. Conflict of interest Nothing to disclose