Abstract
OBJECTIVE: The benefit of endovascular treatment (EVT) in patients with acute ischemic stroke due to large vessel occlusion is now well established. EVT is highly effective for treating embolic occlusions; however, there remains ongoing debate regarding the optimal management of underlying intracranial atherosclerotic disease (ICAD). Current approaches often involve a combination of best medical therapy and mechanical rescue strategies, such as intracranial angioplasty or stenting. In this study, we aimed to compare EVT outcomes between patients with ICAD-related strokes and those with cardioembolic strokes. MATERIALS AND METHODS: The study was designed retrospectively. Data of patients admitted to the stroke center were analyzed. The results of the ICAD group were compared with the cardioembolic stroke group. Demographic characteristics, comorbidities, medications, IV rtPA use before EVT, contraindications, radiologic imaging results, and mechanical thrombectomy results were evaluated. Modified Rankin Score (mRS) results at discharge and 3 months were analyzed. At the end of 3 months, those with mRS 0-2 were included in the good outcome group, and those with mRS 3-6 were included in the poor outcome group. In this study, propensity score matching (PSM) was implemented. The logistic regression model was used. RESULTS: A total of 349 patients were included, with 12% classified in the ICAD group and 88% in the cardioembolic group. Through PSM, 40 matched patients were successfully identified in the cardioembolism group, corresponding to 42 patients in the ICAD group. During EVT, dissection (OR: 1.105, 95% CI: 1.002-1.219) and reocclusion after EVT (p = 0.002) rates were statistically significant in the ICAD group. No significant difference in the rate of symptomatic intracerebral hemorrhage (sICH) was observed between the groups (p = 0.892). The ICAD group showed higher rates of failed recanalization (mTICI 0-2b) and worse 3-month mRS scores (mRS 3-6) compared to the cardioembolic group. CONCLUSION: In this comparative study of EVT outcomes in ICAD-related and cardioembolic strokes, no significant difference was seen in the rate of post-procedural hemorrhagic complications. It was observed that 3-month poor outcome rates were higher in acute stroke patients with ICAD compared to cardioembolic strokes. We revealed that patients with ICAD presenting with acute ischemic stroke demonstrated higher rates of complications (dissection) and lower recanalization rates following EVT. These results highlight the need for tailored therapeutic strategies and careful procedural planning in patients with ICAD to improve clinical outcomes.