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

Abstract 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