Abstract DP315: Expanding Treatment Options for Acute Ischemic Stroke Using Hyperacute Magnetic Resonance Imaging

Introduction: Hyperacute MRI (hMRI) has been increasingly implemented in the evaluation of acute ischemic stroke (AIS) to expand eligibility for thrombolysis or thrombectomy in patients who would otherwise be excluded. In the setting of suspected stroke mimic, wake-up stroke, or computed tomography (CT) contrast allergy, hMRI can “rule in” a recent-onset stroke or large vessel occlusion (LVO), thereby converting otherwise ineligible patients into candidates for acute treatment. Despite these advantages, hMRI is resource-intensive and its yield remains uncertain. Using a large hMRI database, we examined treatment yield, workflow, and safety across different clinical indications. Methods: We retrospectively reviewed prospectively collected data on all consecutive patients who underwent hMRI for code stroke at a tertiary center between June 2018 and November 2024. Indications were categorized as: (1) stroke mimic (