Abstract Number: Esoc2026a1340 Reasons for Not Performing Endovascular Treatment in Patients With Acute Ischaemic Stroke: A Population Based Study

Abstract Background and aims Despite the widespread adoption of endovascular treatment (EVT), real-world data on reasons for EVT exclusion and their temporal evolution remain scarce. We aimed to analyze these reasons in key subgroups of patients with acute ischaemic stroke (AIS) included in the Catalonian Stroke Code (CICAT) registry. Methods Observational, population-based study including patients with AIS recorded in the CICAT registry (2019-2023). EVT exclusion reasons were selected by treating physicians based on clinical judgment and contemporaneous guidelines. Descriptive analyses were performed in the overall cohort and by sex and time period (2019–2020, 2021–2022, 2023) using chi-square tests and adjusted standardized residuals (ASR). Results Among 25,385 patients with AIS, 5,947 (23%) received EVT. The main reason for exclusion was absence of large vessel occlusion (LVO) (59%), followed by unfavorable mRS score (9%), low NIHSS score (9%), and low ASPECTS (6%). Exclusion reasons differed significantly by sex (χ2 = 361.5, P 0.001). ASR analysis showed women disproportionately excluded for unfavorable mRS (14% vs. 5%) and men for low NIHSS (10% vs. 8%). Exclusion reasons changed significantly over time (χ2 = 277.4, P 0.001), with ASR analysis demonstrating a reduction in exclusions due to unfavorable mRS and low ASPECTS and an increase in exclusions related to low NIHSS in the most recent period. Conclusions Absence of LVO remains the main barrier to EVT, currently between 6-9% of patients are excluded for low ASPECTS, unfavorable mRS or low NIHSS scores. Exclusion patterns differ by sex and have shifted over time, aligning with emerging evidence. Conflict of interest Melissa Coronel: nothing to disclose, María Constanza Domine: nothing to disclose, Nerea Blanco: nothing to disclose, Alejandro Martínez: nothing to disclose, Luis Prats: nothing to disclose, Joan Miquel Fernández Vidal: nothing to disclose, Marina Guasch: nothing to disclose, Pol Camps: nothing to disclose, Garbiñe Ezcurra: nothing to disclose, Álvaro Lambea: nothing to disclose, Joan Martí: nothing to disclose, Natalia Pérez de la Ossa: nothing to disclose, Anna Ramos: nothing to disclose.