Abstract Number: Esoc2026a2488 Endovascular Treatment in Low Aspects: Real-World Data From a Tertiary Portuguese Center

Background and aims Randomized trials have demonstrated benefit from endovascular treatment (EVT) in acute ischaemic stroke with low ASPECTS. We evaluated functional outcomes after EVT in low-ASPECTS patients treated in routine clinical practice according to practitioners’ reasoning, and identified factors associated with outcome. Methods We retrospectively included consecutive anterior-circulation LVO-AIS patients with baseline CT-ASPECTS 0–5 admitted to a tertiary centre between January 2020-September 2025, identified through keyword searches of CT/CTA/angiography reports. The primary outcome was 90-day modified Rankin Scale(mRS), analysed using ordinal logistic regression adjusted for age, NIHSS, pre-stroke mRS, ASPECTS, onset-to-treatment time, and complications. Results are expressed as common odds ratios(cORs) with 95% confidence intervals(CIs). Results We included 69 patients (58% female; mean age 75.3±15.2 years); EVT was performed in 31(44.9%). Compared with non-EVT patients, those receiving EVT were younger (68.9 vs 80.6 years), had lower pre-stroke disability (median mRS 0 vs 2), higher ASPECTS (4.7 vs 3.7), and more often received IV thrombolysis (75% vs 38.6%). Vascular risk factors were similar except for hypertension (31.9% vs 68.1%). Overall complication rates did not differ. EVT was independently associated with a shift towards better 90-day outcome (OR 5.8; 95% CI 1.7–19.9;p=0.005), and was protective against catastrophic outcome (mRS 5–6)(OR 0.09; 95% CI 0.01–0.59). Conclusions In this real-world cohort of low-ASPECTS patients, EVT was associated with significantly better 90-day functional outcomes despite high-risk profile. These data support EVT in carefully selected low-ASPECTS patients and complement recent randomized evidence. Conflict of interest Maria Carlos Pereira: nothing to disclose Figure 1 - belongs to Conclusions