Effectiveness of Immediate Angioplasty or Stenting on Functional Outcomes in Acute Ischemic Stroke With Severe Intracranial Stenosis.

Abstract (English)

BACKGROUND AND OBJECTIVES: The efficacy of endovascular treatment for acute large vessel occlusion strokes has been demonstrated, but whether it can improve functional outcomes in patients with acute ischemic stroke (AIS) who only present with severe large vessel stenosis without occlusion has not yet been studied. This study investigates the effectiveness of immediate angioplasty or stenting on functional outcomes in AIS patients with severe intracranial stenosis without occlusion. METHODS: We retrospectively included patients with AIS with symptom onset within 24 hours and imaging-confirmed severe intracranial stenosis (70%-99%, Warfarin Asprin Symptomatic Intracranial Disease criteria) of the culprit vessel from 7 centers in China between January 1, 2020, and December 31, 2024. We compared patients undergoing immediate angioplasty or stenting with those receiving standard medical treatment (SMT) alone. The primary outcome was the distribution of modified Rankin Scale (mRS) scores at 90 days. The treatment effect was estimated through multivariable adjusted models and inverse probability of treatment weighting (IPTW). Safety outcomes included symptomatic intracranial hemorrhage (sICH) within 24 hours and mortality within 90 days. RESULTS: A total of 242 patients were included, with a mean age of 65.7 years, and 86 patients (35.5%) were female. Ninety-six (39.7%) patients underwent immediate angioplasty or stenting, and 146 (60.3%) received SMT. The median 90-day mRS score was 1 (interquartile range 0-3) in the immediate angioplasty or stenting group and 1 (interquartile range 1-3) in the SMT group. The immediate angioplasty or stenting group showed a shift toward better functional outcomes on the mRS scores (adjusted common odds ratio [OR] 2.73 [95% CI 1.49-5.00], <i>p</i> = 0.001; after IPTW, OR 2.50 [95% CI 1.72-3.63], <i>p</i> < 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], <i>p</i> = 0.46) or mortality (2.1% vs 1.4%; adjusted hazard ratio 1.01 [95% CI 0.92-1.11], <i>p</i> = 0.93). DISCUSSION: Among patients with AIS with severe intracranial stenosis without occlusion, immediate angioplasty or stenting was associated with improved 90-day functional outcomes compared with SMT alone. No significant difference was observed in the incidence of sICH or mortality. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that in AIS patients with severe intracranial stenosis, immediate angioplasty or stenting was associated with improved 90-day functional outcomes compared with SMT.