Abstract Background and aims The effectiveness of immediate angioplasty or stenting on functional outcomes in acute ischemic stroke (AIS) patients who only present with severe large vessel stenosis without occlusion has not yet been studied. Methods AIS patients from seven stroke centers in China were retrospectively included, with a symptom onset within 24 hours and imaging-confirmed severe stenosis of the culprit vessel. The study compares patients who underwent immediate angioplasty or stenting to those who received standard medical treatment (SMT) alone. The primary outcome was the distribution of modified Rankin Scale (mRS) scores at 90 days, and safety outcomes included symptomatic intracranial hemorrhage (sICH) within 24 hours and mortality within 90 days. Results A total of 242 patients were included (mean age 65.7 years (SD, 12.3); median baseline NIHSS score 5 (IQR, 2-8)). 96 (39.7%) patients underwent immediate angioplasty or stenting, and 146 (60.3%) received SMT. The immediate angioplasty or stenting group showed a shift toward better functional outcomes on the mRS (median score 1 IQR, 0 to 3 vs. 1 IQR, 1 to 3; adjusted common odds ratio, 2.73 95% CI 1.50 to 4.99, P = 0.001). There was no significant difference in the incidence of sICH (1.0% vs. 1.4%; adjusted risk ratio, 0.36 95% CI, 0.02-5.35, P = 0.46) or mortality (2.1% vs. 1.4%; adjusted hazard ratio, 1.01 95% CI, 0.92-1.11, P = 0.93). Conclusions Among AIS patients with severe intracranial stenosis without occlusion, immediate angioplasty or stenting was associated with improved functional outcomes compared to SMT, with no significant difference in safety outcomes. Conflict of interest Xi Chen, Zhenhong Deng, Yanting Chen, Haoyang Sun, Xiaoming Rong, Jinyuan Wang, Mengqi Liu, Yongteng Xu, Songhua Xiao, Xinguang Yang, Yamei Tang: nothing to disclose.
Chen et al. (2026) studied this question.