Abstract Number: Esoc2026a2350 Early Ischaemia on Low-Field Portable Mri After Aneurysmal Subarachnoid Hemorrhage: Association With Delayed Cerebral Ischaemia and 90-Day Outcome

Abstract Background and aims Early ischaemic injury contributes to delayed cerebral ischaemia (DCI) and poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). We examined whether the presence and temporal evolution of early ischaemia on low-field portable MRI (LF-pMRI) predict DCI and 90-day functional outcome. Methods We analyzed consecutive aSAH patients from a single centre in the RESCUE-SAH registry who underwent LF-pMRI within 72 hours of admission. Serial LF-pMRI was performed on days 2, 3, and 7. The primary outcome was unfavorable 90-day outcome (modified Rankin Scale mRS 3–6); the secondary outcome was DCI. Associations were assessed using multivariable logistic regression adjusting for baseline clinical severity and radiographic grades. Results Among 100 patients, early ischaemia on LF-pMRI was present in 53 (53%). Unfavorable 90-day outcome occurred in 23/53 (43.4%) patients with early ischaemia versus 3/47 (6.4%) without (P 0.01). DCI occurred in 39/53 (73.6%) versus 4/47 (8.5%), respectively (P 0.01). After adjustment, early ischaemia remained associated with unfavorable 90-day outcome (adjusted odds ratio aOR 17.48, 95% CI 3.75–112.99) and DCI (aOR 23.82, 95% CI 6.58–111.58). Dynamic LF-pMRI markers, including ADC and T2-FLAIR signal intensity ratios and ischaemic lesion growth, were independently associated with both endpoints. Conclusions Early ischaemia detected by bedside LF-pMRI identifies aSAH patients at high risk of DCI and poor 90-day outcome. Serial LF-pMRI may enable pragmatic early risk stratification, warranting multicentre validation and evaluation of risk-guided prevention strategies. Conflict of interest nothing to disclose. Figure 1 - belongs to Methods Table 2 - belongs to Results Table 3 - belongs to Conclusions