Abstract Number: Esoc2026ys109 Prognostic Impact of Sequential Serum Biomarkers and Multimodal Ct Imaging on Clinical Outcomes After Extended-Window Mechanical Thrombectomy in Acute Ischemic Stroke

Abstract Background and aims Clinical outcome prognostic of acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) beyond 6 hours from symptom onset remains challenging. While multimodal CT provides valuable information about brain parenchyma status, biological processes such as inflammation, hemostatic disturbances, and blood–brain barrier disruption may influence outcomes. The role of sequential serum biomarker monitoring in this context is not fully determined. The aim of the study is to assess whether dynamic changes in serum biomarkers, particularly matrix metalloproteinase-9 (MMP-9), alongside multimodal CT imaging, could improve prognostic evaluation of AIS patients undergoing MT in the extended window (6–24 hours). Methods The ongoing prospective observational study includes AIS patients treated with MT at a comprehensive stroke center. Baseline multimodal CT (non-contrast CT, CT angiography, CT perfusion) is used to characterize ischemic core, penumbra, and ASPECTS. Serum biomarkers of inflammation, hemostasis, and blood–brain barrier integrity (MMP-9), are measured at admission, 24 and 48 hours from stroke onset. Outcomes comprise early neurological deterioration, hemorrhagic transformation, and functional status (modified Rankin Scale) at discharge and 90 days. Results To date, 46 patients have complete imaging and biomarker data; 90-day follow-up is ongoing. Early observations suggest sequential biomarker assessment is feasible and may complement imaging to better stratify risk in AIS undergoing MT in the extended window (6–24 hours). Perspectives Integrating biomarker dynamics with multimodal CT imaging may enhance early prognostic stratification after extended-window mechanical thrombectomy and support individualized post-acute management in routine stroke care. Conflict of interest This study was funded by the National Agency for Research and Development (NARD) of the Republic of Moldova, research project no. 25.80012.8007.09TC.