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Endovascular Therapy vs Medical Management for Isolated Anterior Cerebral Artery Acute Ischemic Stroke
TAKE-HOME MESSAGE
- This observational, multicenter, cohort study investigated the utility of endovascular thrombectomy (EVT) in patients with acute ischemic stroke due to isolated anterior cerebral artery occlusion. Most patients had A2/A3 occlusions, and the median NIHSS score was 15 in the EVT group and 9 in the best medical therapy (BMT) group. After adjusting for baseline differences, compared with BMT alone, EVT did not provide any additional benefit to improve functional (measured by the modified Rankin Scale), neurological (measured by the NIHSS), and mortality outcomes despite more than 90% successful reperfusion and low complication rates.
- Although EVT shows high procedural success, it does not significantly improve functional outcomes compared with BMT in patients with isolated anterior cerebral artery occlusion, leading to relatively high NIHSS scores. Similar to studies on other medium-vessel occlusions, this study underscores the need for further research to establish clearer guidelines.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Isolated anterior cerebral artery occlusions (ACAo) in patients with acute ischemic stroke present significant challenges due to their rarity. The efficacy and safety of endovascular therapy (EVT) in comparison with best medical therapy (BMT) for ACAo remains unclear. This study aimed to assess the outcomes of these treatments.
METHODS
This multinational, multicenter study analyzed data from the MAD-MT registry. Data were collected retrospectively from 37 sites across North America, Asia, and Europe. Inverse probability of treatment weighting (IPTW) was applied to balance confounding variables. The primary outcome was functional independence (modified Rankin Scale (mRS) scores of 0-2) at 90 days. Secondary outcomes included excellent outcomes (mRS 0-1), mortality at 90 days, and NIH Stroke Scale (NIHSS) score on day 1 post treatment.
RESULTS
Of the 108 patients, 36 received BMT and 72 underwent EVT. The median age was 75 years, and 56% were male. At 90 days, 40% of patients achieved mRS 0-2, with no significant difference between EVT and BMT (38% vs 45%, p=0.46). Procedural success (mTICI 2b-3) was 91% in the EVT group, with a sICH rate of 2.9%. IPTW-adjusted analysis showed no significant difference between EVT and BMT for functional independence (OR 1.17, 95% CI 0.23 to 6.02, p=0.85), mortality (25% vs 21%, p=0.71) or day 1 NIHSS scores (Beta 2.2, 95% CI -0.51 to 4.8, p=0.11).
CONCLUSIONS
EVT showed high procedural success but did not significantly improve functional outcomes or mortality compared with BMT in patients with ACAo. Further randomized trials are needed to clarify EVT's role in ACAo.
Additional Info
Disclosure statements are available on the authors' profiles:
Endovascular therapy versus medical management in isolated anterior cerebral artery acute ischemic stroke: a multinational multicenter propensity score-weighted study
2024 Nov 28;[EPub Ahead of Print], HA Salim, B Pulli, V Yedavalli, F Milhem, B Musmar, N Adeeb, DA Lakhani, MA Essibayi, JJ Heit, TD Faizy, K El Naamani, N Henninger, SH Sundararajan, AL Kuhn, J Khalife, S Ghozy, L Scarcia, LL Yeo, BY Tan, RW Regenhardt, NM Cancelliere, A Rouchaud, J Fiehler, SA Sheth, AS Puri, C Dyzmann, M Colasurdo, L Renieri, JP Filipe, P Harker, RA Radu, M Abdalkader, P Klein, TR Marotta, J Spears, T Ota, A Mowla, P Jabbour, A Biswas, F Clarençon, JE Siegler, TN Nguyen, R Varela, A Baker, D Altschul, N Gonzalez, MA Möhlenbruch, V Costalat, B Gory, P Stracke, C Hecker, G Marnat, H Shaikh, CJ Griessenauer, DS Liebeskind, A Pedicelli, AM Alexandre, I Tancredi, E Kalsoum, B Lubicz, AB Patel, V Mendes Pereira, M Wintermark, A Guenego, AA DmytriwFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.