Comparative analysis of outcome-associated factors following endovascular treatment for intracranial atherosclerotic disease and cardioembolism: A subanalysis of the K-NET registry

Background The efficacy of endovascular treatment (EVT) for intracranial atherosclerotic disease (ICAD) remains unclear. This study compared procedural and clinical outcomes of EVT for ICAD-related and cardiogenic embolism (CE)-related large vessel occlusion (LVO) using data from the Kanagawa Intravenous and Endovascular Treatment of Acute Ischemic Stroke registry, a prospective, multicenter observational study. Methods Of 3187 EVTs from 2018 to 2021, 2047 anterior circulation occlusions included 305 ICAD and 1742 CE cases. The primary endpoint was favorable functional outcome (mRS 0–2) at 90 days; secondary endpoints included recanalization rates, symptomatic intracranial hemorrhage, and puncture-to-recanalization time. Results ICAD-LVO patients were younger, had lower NIHSS scores, and showed a lower proportion of recanalization (74% vs. 91%, p < 0.0001) and longer procedural times (66 vs. 43 min, p < 0.0001) than CE patients. Symptomatic hemorrhage was also more frequent (8.5% vs. 5.2%, p = 0.0267). Despite these differences, favorable outcomes were comparable (41% vs. 38%, p = 0.3157). Onset-to-recanalization time was significantly associated with outcome in CE (aOR: 0.99, 95% CI: 0.99–1.000, p = 0.0147) but not in ICAD. DWI-ASPECTS strongly predicted favorable outcome in both groups (ICAD: aOR: 1.26, 95% CI: 1.085–1.46, p = 0.0024; CE: aOR: 1.30, 95% CI: 1.23–1.38, p < 0.0001). Conclusions EVT for ICAD-LVO was associated with a lower proportion of recanalization, longer procedure times and poorer procedural outcomes but similar 90-day functional outcomes compared with CE-LVO. In ICAD, DWI-ASPECTS was a key prognostic factor, while onset-to-recanalization time had limited impact, highlighting distinct pathophysiological mechanisms. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05213533