Abstract Number: Esoc2026a1660 Preserved Posterior Circulation Neurovascular Coupling Is Associated With Hemianopia Recovery at 3 Months After Ischemic Stroke

Background and aims Homonymous hemianopia is disabling after ischemic stroke and early prognostic markers are limited. We evaluated whether an early posterior cerebral artery (PCA) neurovascular coupling (NVC) response measured by transcranial Doppler (TCD) during visual stimulation is associated with hemianopia recovery at 3 months. Methods Subanalysis of a prospective cohort (NCT06735274). Adults with acute ischemic stroke and homonymous hemianopia underwent bilateral PCA transcranial Doppler within 72 h during standardized flickering checkerboard stimulation. Exposure was the prespecified 20-s peak NVC amplitude in the PCA supplying the affected occipital cortex (present vs absent). NVC was considered absent if below the lower limit of normal (mean–2SD) from a healthy-control dataset. At 3 months, a stroke specialist blinded to NVC assessed recovery by neurological exam. Associations were tested with Fisher’s exact test and logistic regression (primary model adjusted for age and baseline NIHSS; sensitivity model adjusted for follow-up CT ASPECTS at 24–48h). Results Twenty patients were included; 14/20 (70.0%) recovered. NVC was present in 16/20 (80.0%). Recovery occurred in 13/16 (81.3%) with NVC present versus 1/4 (25.0%) with absent NVC (Fisher p=0.061). In multivariable analysis adjusted for age and baseline NIHSS, NVC presence remained associated with recovery (aOR 40.87, 95% CI 1.81–920.59; p=0.020). In a sensitivity model adjusted for follow-up CT ASPECTS (24–48 h), the association persisted (aOR 167.34, 95% CI 1.72–16311.89; p=0.028). Conclusions Preserved early PCA NVC was associated with higher odds of hemianopia recovery at 3 months. Bedside NVC supports early visual outcome stratification and warrants validation in larger cohorts. Conflict of interest Bruno Carvalho: nothing to disclose; Juliana Ferreira: nothing to disclose; Guilherme Gama: nothing to disclose; Goreti Moreira: nothing to disclose; Elsa Azevedo: nothing to disclose; Luísa Fonseca: nothing to disclose; Pedro Castro: nothing to disclose.