Endovascular thrombectomy versus medical management for moderate-to-severe anterior cerebral artery occlusion stroke
Huanwen Chen, Mihir Khunte, Marco Colasurdo
Background There are no established patient selection criteria for endovascular thrombectomy (EVT) for anterior cerebral artery (ACA) stroke.
Methods This was a retrospective cohort study of the 2016–2020 National Inpatient Sample in the United States. Isolated ACA-occlusion stroke patients with moderate-to-severe stroke symptoms (NIH stroke scale [NIHSS]=/+6) were included. Primary outcome was hospital discharge to home with self-care. Secondary outcomes include in-hospital mortality and intracranial hemorrhage (ICH). Confounders were accounted for by multivariable logistic regression.
Results 6685 patients were included; 335 received EVT. Compared to medical management (MM), EVT patients were younger (mean 67.2 versus 72.2 years; p=0.014) and had higher NIHSS (mean 16.0 versus 12.5; p<0.001). EVT was numerically but not statistically significantly associated with higher odds of home discharge compared to MM (aOR 2.26 [95%CI 0.99-5.17], p=0.053). EVT was significantly associated with higher odds of home discharge among patients with NIHSS 10 or greater (aOR 3.35 [95%CI 1.06-10.58], p=0.039), those who did not receive prior thrombolysis (aOR 3.96 [95%CI 1.53-10.23], p=0.005), and those with embolic stroke etiology (aOR 4.03 [95%CI 1.21-13.47], p=0.024). EVT was not significantly associated with higher rates of mortality (aOR 1.93 [95%CI 0.80–4.63], p=0.14); however, it was significantly associated with higher rates of ICH (22.4% vs. 8.5%, p<0.001).
Conclusion EVT was associated with higher odds of favorable short-term outcomes for moderate-to-severe ACA-occlusion stroke in select patients. Future studies are needed to confirm the efficacy of EVT in terms of longer term neurological outcomes.