Background: Acute ischemic stroke (AIS) caused by severe intracranial atherosclerotic stenosis (ICAS) presents with significant hemodynamic compromise and poor functional outcome. It remains unclear whether immediate angioplasty or stenting could improve functional outcome in AIS patients with severe ICAS who present within 24 hours of symptom onset and are not indicated for mechanical thrombectomy. Method: AIS patients with symptom onset within 24 hours and imaging-confirmed severe ICAS (70%-99%) in the culprit vessel, admitted to 7 stroke centers in China between January 2020 and December 2024, were included and divided into the immediate endovascular treatment (EVT) group with angioplasty or stenting, and the standard medical treatment (SMT) group. The primary outcome was the distribution of modified Rankin Scale (mRS) scores at 90 days. Symptomatic intracranial hemorrhage (sICH) within 24 hours and mortality within 90 days were assessed as safety outcomes. Multivariable models were used to estimate the effectiveness of immediate EVT. Results: A total of 242 patients were included, with a mean age of 65.7 years (SD, 12.3) and a median baseline NIHSS score of 5 (IQR, 2-8). 96 (39.7%) of the patients underwent immediate EVT, and 146 (60.3%) received SMT. The median 90-day mRS score was 1 (IQR, 0-3) in the immediate EVT group and 1 (IQR, 1-3) in the SMT group. The immediate EVT group showed a shift towards better functional outcomes on the mRS (adjusted common odds ratio 2.73 95% CI, 1.50 to 4.99; P = 0.001). There was no significant difference in sICH within 24 hours (1.0% vs. 1.4%; adjusted RR, 0.36 95% CI, 0.02-5.35; P = 0.456) and mortality within 90 days (2.1% vs. 1.4%; adjusted HR, 1.01 95% CI, 0.92-1.11; P = 0.934). Conclusions: In patients with AIS due to severe ICAS, immediate EVT was associated with an improved 90-day functional outcome compared with SMT alone, but not with an increased risk of sICH or mortality. Further prospective, multicenter, randomized trials are warranted to validate the efficacy of immediate EVT for AIS patients due to severe ICAS.
Chen et al. (Thu,) studied this question.
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