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Introduction <p>The optimal revascularization treatment in patients with acute ischemic stroke (AIS) and isolated extracranial artery occlusion remains uncertain.</p> <p>We aimed to compare outcomes between endovascular treatment (EVT) and intravenous thrombolysis (IVT) alone in patients with AIS and isolated extracranial artery occlusion without concomitant ipsilateral large intracranial occlusion treated ≤ 4.5&#xa0;h of onset.</p> Methods <p>We retrospectively analyzed prospectively collected data from two multicenter registries (IRETAS for EVT and SITS-ISTR for IVT). Primary efficacy endpoints were 3-month modified Rankin Scale (mRS) score 0–1 and 0–2. Primary safety endpoints were symptomatic intracranial hemorrhage (sICH) and 3-month mortality. Multivariable logistic regression was used to adjust for imbalances in demographics, clinical variables, stroke etiology data, and procedure data.</p> Results <p>A total of 793 patients were included in the study (EVT, <i>n</i> = 358; IVT alone, <i>n</i> = 389; control angiography, <i>n</i> = 46), of whom 633 with extracranial internal carotid artery (ICA) occlusion and 160 with extracranial vertebral artery (VA) occlusion. In the isolated extracranial ICA or VA occlusions, EVT was associated with lower rates of mRS 0–1 (aOR: 0.45, 95% CI: 0.29–0.71) and mRS 0–2 (aOR: 0.42, 95% CI: 0.27–0.66), higher rate of mortality (aOR: 2.91, 95% CI: 1.62–5.24). In the isolated extracranial ICA occlusion, IVT was associated with higher rates of mRS 0–2 (aOR: 2.63, 95% CI: 1.13–6.08) compared with control angiography.</p> Conclusions <p>Our data support IVT ≤ 4.5&#xa0;h after onset as first-line therapy in eligible patients with AIS and isolated extracranial artery occlusion whereas the benefit of EVT appears limited and warrants further investigation in RCTs.</p>

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Revascularization treatments within 4.5 h after onset in acute ischemic stroke with isolated extracranial artery occlusion

  • 期刊论文

  • 发表日期：

    2026年3月25日

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  • Manuel Cappellari,
  • Ettore Nicolini,
  • Valentina Saia,
  • Giovanni Pracucci,
  • Ludovica Guido,
  • Ilaria Casetta,
  • Enrico Fainardi,
  • Sandra Bracco,
  • Rossana Tassi,
  • Antonio Laiso,
  • Patrizia Nencini,
  • Maria Ruggiero,
  • Marco Longoni,
  • Andrea Saletti,
  • Alessandro De Vito,
  • Nicola Cavasin,
  • Adriana Critelli,
  • Roberto Menozzi,
  • Alessandro Pezzini,
  • Mauro Bergui,
  • Giovanni Bosco,
  • Alessio Comai,
  • Enrica Franchini,
  • Claudia Rolla Bigliani,
  • Tiziana Benzi Markushi,
  • Emilio Lozupone,
  • Sabino D’Agostino,
  • Stefano Vallone,
  • Guido Bigliardi,
  • Andrea Boghi,
  • Andrea Naldi,
  • Ivan Gallesio,
  • Alessandro Canessa,
  • Michele Besana,
  • Alessia Giossi,
  • Luigi Simonetti,
  • Andrea Zini,
  • Valerio Da Ros,
  • Giordano Lacidogna,
  • Nicola Burdi,
  • Angelica Tinelli,
  • Sergio Lucio Vinci,
  • Paolino La Spina,
  • Mauro Plebani,
  • Francesco Valletta,
  • Manuela De Michele,
  • Antonio Ciacciarelli,
  • Andrea Romi,
  • Alessandra Persico,
  • Guido Andrea Lazzarotti,
  • Gaia Mignani,
  • Marco Perri,
  • Federica De Santis,
  • Antioco Sanna,
  • Elena Coco,
  • Gianluca Galvano,
  • Eleonora Saracco,
  • Matteo Alberti,
  • Paolo Invernizzi,
  • Massimiliano Allegritti,
  • Stefano Caproni,
  • Luigi Chiumarulo,
  • Marco Petruzzellis,
  • Giuseppe Carità,
  • Monia Russo,
  • Edoardo Puglielli,
  • Alfonsina Casalena,
  • Ahmed Niaz,
  • Salvatore Mangiafico,
  • Danilo Toni

摘要

Introduction

The optimal revascularization treatment in patients with acute ischemic stroke (AIS) and isolated extracranial artery occlusion remains uncertain.

We aimed to compare outcomes between endovascular treatment (EVT) and intravenous thrombolysis (IVT) alone in patients with AIS and isolated extracranial artery occlusion without concomitant ipsilateral large intracranial occlusion treated ≤ 4.5 h of onset.

Methods

We retrospectively analyzed prospectively collected data from two multicenter registries (IRETAS for EVT and SITS-ISTR for IVT). Primary efficacy endpoints were 3-month modified Rankin Scale (mRS) score 0–1 and 0–2. Primary safety endpoints were symptomatic intracranial hemorrhage (sICH) and 3-month mortality. Multivariable logistic regression was used to adjust for imbalances in demographics, clinical variables, stroke etiology data, and procedure data.

Results

A total of 793 patients were included in the study (EVT, n = 358; IVT alone, n = 389; control angiography, n = 46), of whom 633 with extracranial internal carotid artery (ICA) occlusion and 160 with extracranial vertebral artery (VA) occlusion. In the isolated extracranial ICA or VA occlusions, EVT was associated with lower rates of mRS 0–1 (aOR: 0.45, 95% CI: 0.29–0.71) and mRS 0–2 (aOR: 0.42, 95% CI: 0.27–0.66), higher rate of mortality (aOR: 2.91, 95% CI: 1.62–5.24). In the isolated extracranial ICA occlusion, IVT was associated with higher rates of mRS 0–2 (aOR: 2.63, 95% CI: 1.13–6.08) compared with control angiography.

Conclusions

Our data support IVT ≤ 4.5 h after onset as first-line therapy in eligible patients with AIS and isolated extracranial artery occlusion whereas the benefit of EVT appears limited and warrants further investigation in RCTs.