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Multicenter Study
. 2024 Mar;34(1):125-133.
doi: 10.1007/s00062-023-01342-7. Epub 2023 Sep 4.

Endovascular Treatment for Acute Isolated Internal Carotid Artery Occlusion : A Propensity Score Matched Multicenter Study

Daniel P O Kaiser  1   2 , Tilman Reiff  3 , Ulrich Mansmann  4 , Daniela Schoene  5   6 , Davide Strambo  7 , Patrik Michel  7 , Mohamad Abdalkader  8 , Thanh N Nguyen  9 , Matthias Gawlitza  10 , Markus A Möhlenbruch  11 , Peter A Ringleb  3 , Volker Puetz  5   6 , Johannes C Gerber  12   5 , Simon Nagel  3   13
Affiliations
Multicenter Study

Endovascular Treatment for Acute Isolated Internal Carotid Artery Occlusion : A Propensity Score Matched Multicenter Study

Daniel P O Kaiser et al. Clin Neuroradiol. 2024 Mar.

Abstract

Purpose: The benefit of endovascular treatment (EVT) in patients with acute symptomatic isolated occlusion of the internal carotid artery (ICA) without involvement of the middle and anterior cerebral arteries is unclear. We aimed to compare clinical and safety outcomes of best medical treatment (BMT) versus EVT + BMT in patients with stroke due to isolated ICA occlusion.

Methods: We conducted a retrospective multicenter study involving patients with isolated ICA occlusion between January 2016 and December 2020. We stratified patients by BMT versus EVT and matched the groups using propensity score matching (PSM). We assessed the effect of treatment strategy on favorable outcome (modified Rankin scale ≤ 2) 90 days after treatment and compared reduction in NIHSS score at discharge, rates of symptomatic intracranial hemorrhage (sICH) and 3‑month mortality.

Results: In total, we included 149 patients with isolated ICA occlusion. To address imbalances, we matched 45 patients from each group using PSM. The rate of favorable outcomes at 90 days was 56% for EVT and 38% for BMT (odds ratio, OR 1.89, 95% confidence interval, CI 0.84-4.24; p = 0.12). Patients treated with EVT showed a median reduction in NIHSS score at discharge of 6 points compared to 1 point for BMT patients (p = 0.02). Rates of symptomatic intracranial hemorrhage (7% vs. 4%; p = 0.66) and 3‑month mortality (11% vs. 13%; p = 0.74) did not differ between treatment groups. Periprocedural complications of EVT with early neurological deterioration occurred in 7% of cases.

Conclusion: Although the benefit on functional outcome did not reach statistical significance, the results for NIHSS score improvement, and safety support the use of EVT in patients with stroke due to isolated ICA occlusion.

Keywords: Angiography; Cervical; Intervention; Stroke; Thrombectomy.

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Conflict of interest statement

D.P.O. Kaiser, T. Reiff, U. Mansmann, D. Schoene, D. Strambo, P. Michel, M. Abdalkader, T.N. Nguyen, M. Gawlitza, M.A. Möhlenbruch, P.A. Ringleb, V. Puetz, J.C. Gerber and S. Nagel declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of study design and patient selection. EVT endovascular treatment, BMT best medical treatment, pmRS prestroke modified Rankin Scale score, PSM propensity score matching
Fig. 2
Fig. 2
Modified Rankin scale (mRS) score 90 days after stroke by treatment group. Sample after propensity score matching. BMT best medical treatment (n = 45), EVT endovascular treatment (n = 45). Analysis with for matching stratified Wilcoxon-Mann-Whitney test
See this image and copyright information in PMC

References

    1. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–1731. doi: 10.1016/S0140-6736(16)00163-X. - DOI - PubMed
    1. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344–e418. doi: 10.1161/STR.0000000000000211. - DOI - PubMed
    1. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–1030. doi: 10.1056/NEJMoa1414905. - DOI - PubMed
    1. Berkhemer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20. doi: 10.1056/NEJMoa1411587. - DOI - PubMed
    1. Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–2306. doi: 10.1056/NEJMoa1503780. - DOI - PubMed

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