Abstract 397: Functional Recovery After Full (TICI 2c‐3) Reperfusion: An mRS‐Guided Analysis

Background While TICI 2c‐3 reperfusion is regarded as the strongest predictor of favorable outcomes after endovascular thrombectomy (EVT), not all patients with angiographic success achieve functional independence. Prior studies often examine the full range of reperfusion grades, limiting insights into determinants of recovery once optimal reperfusion is reached. This study focuses exclusively on patients with TICI 2c‐3 reperfusion to identify clinical, imaging, and procedural factors associated with 90‐day outcomes. Methods We retrospectively analyzed 280 consecutive patients who achieved final TICI 2c‐3 reperfusion at a comprehensive stroke network (01/2022‐12/2024). Patients were stratified into favorable (mRS 0‐2, n=145) and unfavorable (mRS 3‐5, n=135) outcomes at 90 days. Baseline demographics, vascular risk factors, stroke severity, imaging findings, procedural metrics, and early neurological recovery were compared. Special emphasis was placed on intra‐procedural efficiency (procedure time, first‐line strategy) and occlusion site distribution, as these are less commonly reported in prior analyses. Categorical variables were compared using chi‐square/Fisher's exact testing, and continuous variables with non‐parametric testing. Results Among 280 patients with TICI 2c‐3 reperfusion, those with unfavorable 90‐day outcomes had higher baseline NIHSS scores (median 18 14‐22 vs 14 9‐19, p<0.001) and worse neurological status at discharge (NIHSS 5 2‐10 vs 2 1‐4, p<0.001). Procedural efficiency differed, with longer procedure times in the unfavorable group (53 41‐68 vs 44 32‐60 minutes, p=0.003). Occlusion site distribution also varied (p=0.044): unfavorable outcomes were associated with more ICA occlusions (10.4% vs 4.8%) and basilar occlusions (5.9% vs 2.8%), whereas favorable outcomes more often had M2 occlusions (37.2% vs 22.2%). Non‐significant but directional trends suggested higher rates of cardiac disease (35.6% vs 24.8%, p=0.067), smoking history (31.1% vs 21.5%, p=0.077), and use of a combined first‐line thrombectomy approach (55.2% vs 43.8%, p=0.066) among patients with unfavorable outcomes. Symptomatic intracranial hemorrhage occurred exclusively in the unfavorable group (2.2% vs 0%). No significant differences were observed in age, sex, ASPECTS, platelet count, glucose, early‐window presentation, IV thrombolysis use, anesthesia modality, or vascular risk factors including hypertension, diabetes, and atrial fibrillation. Conclusion Despite achieving complete reperfusion (TICI 2c‐3), nearly half of the patients did not attain functional independence at 90 days. By focusing exclusively on this optimally reperfused cohort, we identified baseline severity, early neurological recovery, intra‐procedural efficiency, and occlusion site distribution as major determinants of functional outcome. These findings underscore that angiographic success alone is insufficient and highlight the need for procedural optimization, individualized patient selection, and prognostic counseling in stroke care. image