2026 American Academy of Neurology Abstract Website

Isabella OShea¹, Muhammed Gunduz², Nils Henninger³, Majaz Moonis⁴, Raphael Carandang⁵, Rakhee Lalla³, Danison Emmerson³, Muhammad Ramzan⁶, Thomas Ford⁷, Annie Ferris⁸, Adalia Jun-O'Connell⁹, Kayla Overly³, Bruce Barton³, Brian Silver³
¹UMass Medical school, ²University of Massachusetts Medical School, ³UMass Memorial Medical Center, ⁴University of Massachusetts, Department of Neurology, ⁵University of Massachusetts Medical School/UMASS Memorial Medical Group, ⁶UMMH, ⁷University of Massachusetts Medical Center, ⁸UMass Memorial Neurology Dept., ⁹MRMC

Objective:

We aimed to evaluate whether shorter bed rest yields similar discharge outcomes, in-hospital complications, and readmission rates compared to the standard 24-hour bed rest in acute ischemic stroke (AIS) patients treated with MT +/- IV thrombolysis.

Background:

A minimum of 24-hour bed rest after mechanical thrombectomy (MT) following AIS remains widely practiced, yet its benefit over earlier mobilization is unclear.

Design/Methods:

Consecutive adult AIS patients treated with MT from January 21, 2010, until December 31, 2024, at a single stroke center were included. Standard 24-hour bed rest (before April 8, 2020) was retrospectively compared with the current 12-hour protocol.

Results:

1173 patients were included (638 ≥12h, 535 ≥24h). Mean (s.d.) age was 70.2 (14.7) and 69.2 (14.6). Median (IQR) NIHSS was 14.0 (7-20) and 15.0 (8-21). Mean (s.d.) door-to-puncture times (minutes) were 106.4 (167.9) and 116.8 (157.5). TICI ≥2b was achieved in 97.4% and 95.7% of patients (Likelihood Ratio χ² p=0.20). Favorable discharge location was similar between groups in unadjusted χ²-test of proportions (64.1% vs 65.4%, Likelihood Ratio χ² p=0.64) and multivariable logistic regression analysis (Wald χ² p=0.99; adjusted OR=1.00; 95% CI=0.76:1.31). The frequency of good outcomes (mRS=0-2) by 90 days (37.3% vs. 39.8%, χ² p=0.65) was similar. Unplanned readmission rates at 30 days (8.9 vs. 6.9%, LR χ² p=0.43) and 90 days (19.9% vs. 15.1%, LR χ² p=0.18) were not different. In the ≥12h group, pneumonia rates were higher (unadjusted: 8.2% vs. 5.1%, LR χ² p=0.033; adjusted OR= 1.81 (95% CI= 1.09: 3.01), and median (IQR) length of stay was longer (6.0 days vs. 5.1 days, Wilcoxon p <0.001).

Conclusions:

After adjustment, ≥12h bed rest following AIS treated with MT showed no significant difference in favorable discharge or readmission rates compared to ≥24h. Higher pneumonia rates and longer stays in the ≥12h group likely reflect unmeasured factors, indicating the need for randomized trials.