Comparative analysis of outcome-associated factors following endovascular treatment for intracranial atherosclerotic disease and cardioembolism: A subanalysis of the K-NET registry.

Abstract

BackgroundThe efficacy of endovascular treatment (EVT) for intracranial atherosclerotic disease (ICAD) remains unclear. This study compared procedural and clinical outcomes of EVT for ICAD-related and cardiogenic embolism (CE)-related large vessel occlusion (LVO) using data from the Kanagawa Intravenous and Endovascular Treatment of Acute Ischemic Stroke registry, a prospective, multicenter observational study.MethodsOf 3187 EVTs from 2018 to 2021, 2047 anterior circulation occlusions included 305 ICAD and 1742 CE cases. The primary endpoint was favorable functional outcome (mRS 0-2) at 90 days; secondary endpoints included recanalization rates, symptomatic intracranial hemorrhage, and puncture-to-recanalization time.ResultsICAD-LVO patients were younger, had lower NIHSS scores, and showed a lower proportion of recanalization (74% vs. 91%, p < 0.0001) and longer procedural times (66 vs. 43 min, p < 0.0001) than CE patients. Symptomatic hemorrhage was also more frequent (8.5% vs. 5.2%, p = 0.0267). Despite these differences, favorable outcomes were comparable (41% vs. 38%, p = 0.3157). Onset-to-recanalization time was significantly associated with outcome in CE (aOR: 0.99, 95% CI: 0.99-1.000, p = 0.0147) but not in ICAD. DWI-ASPECTS strongly predicted favorable outcome in both groups (ICAD: aOR: 1.26, 95% CI: 1.085-1.46, p = 0.0024; CE: aOR: 1.30, 95% CI: 1.23-1.38, p < 0.0001).ConclusionsEVT for ICAD-LVO was associated with a lower proportion of recanalization, longer procedure times and poorer procedural outcomes but similar 90-day functional outcomes compared with CE-LVO. In ICAD, DWI-ASPECTS was a key prognostic factor, while onset-to-recanalization time had limited impact, highlighting distinct pathophysiological mechanisms.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT05213533.