Abstract Number: Esoc2026a817 Roke Etiology and Vascular Distribution as Predictors of Early Neurologic Deterioration in Ischemic Stroke Patients

Abstract Background and aims Early neurologic deterioration (END) occurs in a significant proportion of ischemic stroke patients and is linked to worse clinical outcomes. This study aimed to identify which stroke etiologies and vascular territories are most associated with END. Methods We retrospectively analyzed 412 adult ischemic stroke patients admitted to Maadi Military Hospital and Al-Azhar University Hospitals between April 2016 and April 2021 within 48 hours of symptom onset. Stroke etiology was classified as cardioembolic, large vessel, small vessel, other, unknown source, or multiple possible etiologies. END was defined as an increase of ≥2 points on the National Institutes of Health Stroke Scale (NIHSS) within 24 hours of admission. Associations between stroke etiology, vascular distribution, and END were evaluated using crude and backward stepwise regression models. Results Among 412 patients (median age 66 years; 45% female), 140 (34%) experienced END. Infarctions involving the internal carotid artery (ICA) were associated with a markedly higher odds of END (OR 2.95; 95% CI 1.45–6.00; P=0.005). Strokes of unknown etiology had the lowest odds of END in fully adjusted models (OR 0.61; 95% CI 0.39–0.97; P=0.032). Other vascular territories and etiologies showed no statistically significant associations after adjustment. Conclusions In this multicenter cohort, ICA infarctions were independently linked to END, while strokes of unknown etiology carried the lowest risk. Identification of high-risk stroke subtypes may guide monitoring strategies to prevent early deterioration in vulnerable patients. Conflict of interest Nothing to disclose