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Endovascular therapy versus medical management in isolated anterior cerebral artery acute ischemic stroke: a multinational multicenter propensity score-weighted study

Background Isolated anterior cerebral artery occlusions (ACAo) in patients with acute ischemic stroke present significant challenges due to their rarity. The efficacy and safety of endovascular therapy (EVT) in comparison with best medical therapy (BMT) for ACAo remains unclear. This study aimed to...

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Main Authors: Salim, Hamza (Author) , Pulli, Benjamin (Author) , Yedavalli, Vivek (Author) , Milhem, Fathi (Author) , Musmar, Basel (Author) , Adeeb, Nimer (Author) , Lakhani, Dhairya A. (Author) , Essibayi, Muhammed Amir (Author) , Heit, Jeremy Josef (Author) , Faizy, Tobias D. (Author) , Naamani, Kareem El (Author) , Henninger, Nils (Author) , Sundararajan, Sri Hari (Author) , Kuhn, Anna Luisa (Author) , Khalife, Jane (Author) , Ghozy, Sherief (Author) , Scarcia, Luca (Author) , Yeo, Leonard LL (Author) , Tan, Benjamin YQ (Author) , Regenhardt, Robert W. (Author) , Cancelliere, Nicole M. (Author) , Rouchaud, Aymeric (Author) , Fiehler, Jens (Author) , Sheth, Sunil A. (Author) , Puri, Ajit S. (Author) , Dyzmann, Christian (Author) , Colasurdo, Marco (Author) , Renieri, Leonardo (Author) , Filipe, João Pedro (Author) , Harker, Pablo (Author) , Radu, Răzvan Alexandru (Author) , Abdalkader, Mohamad (Author) , Klein, Piers (Author) , Marotta, Thomas R. (Author) , Spears, Julian (Author) , Ota, Takahiro (Author) , Mowla, Ashkan (Author) , Jabbour, Pascal (Author) , Biswas, Arundhati (Author) , Clarençon, Frédéric (Author) , Siegler, James E. (Author) , Nguyen, Thanh N. (Author) , Varela, Ricardo (Author) , Baker, Amanda (Author) , Altschul, David (Author) , Gonzalez, Nestor (Author) , Möhlenbruch, Markus Alfred (Author) , Costalat, Vincent (Author) , Gory, Benjamin (Author) , Stracke, Paul (Author) , Hecker, Constantin (Author) , Marnat, Gaultier (Author) , Shaikh, Hamza (Author) , Griessenauer, Christoph J. (Author) , Liebeskind, David S. (Author) , Pedicelli, Alessandro (Author) , Alexandre, Andrea Maria (Author) , Tancredi, Illario (Author) , Kalsoum, Erwah (Author) , Lubicz, Boris (Author) , Patel, Aman B. (Author) , Pereira, Vitor Mendes (Author) , Wintermark, Max (Author) , Guenego, Adrien (Author) , Dmytriw, Adam A. (Author)
Format: Article (Journal)
Language:English
Published: June 01, 2025
In: Journal of neuroInterventional surgery
Year: 2025, Volume: 17, Issue: e2, Pages: e356-e364
ISSN:1759-8486
DOI:10.1136/jnis-2024-022467
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1136/jnis-2024-022467
Verlag, lizenzpflichtig, Volltext: https://jnis.bmj.com/content/17/e2/e356
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Author Notes:Hamza Adel Salim, Benjamin Pulli, Vivek Yedavalli, Fathi Milhem, Basel Musmar, Nimer Adeeb, Dhairya A. Lakhani, Muhammed Amir Essibayi, Jeremy Josef Heit, Tobias D. Faizy, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kuhn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Leonard LL Yeo, Benjamin YQ Tan, Robert W. Regenhardt, Nicole M. Cancelliere, Aymeric Rouchaud, Jens Fiehler, Sunil A. Sheth, Ajit S. Puri, Christian Dyzmann, Marco Colasurdo, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas R. Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E. Siegler, Thanh N. Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor Gonzalez, Markus A. Möhlenbruch, Vincent Costalat, Benjamin Gory, Paul Stracke, Constantin Hecker, Gaultier Marnat, Hamza Shaikh, Christoph J. Griessenauer, David S. Liebeskind, Alessandro Pedicelli, Andrea Maria Alexandre, Illario Tancredi, Erwah Kalsoum, Boris Lubicz, Aman B. Patel, Vitor Mendes Pereira, Max Wintermark, Adrien Guenego, Adam A. Dmytriw, MAD-MT Investigators

MARC

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245 1 0 |a Endovascular therapy versus medical management in isolated anterior cerebral artery acute ischemic stroke  |b a multinational multicenter propensity score-weighted study  |c Hamza Adel Salim, Benjamin Pulli, Vivek Yedavalli, Fathi Milhem, Basel Musmar, Nimer Adeeb, Dhairya A. Lakhani, Muhammed Amir Essibayi, Jeremy Josef Heit, Tobias D. Faizy, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kuhn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Leonard LL Yeo, Benjamin YQ Tan, Robert W. Regenhardt, Nicole M. Cancelliere, Aymeric Rouchaud, Jens Fiehler, Sunil A. Sheth, Ajit S. Puri, Christian Dyzmann, Marco Colasurdo, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas R. Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E. Siegler, Thanh N. Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor Gonzalez, Markus A. Möhlenbruch, Vincent Costalat, Benjamin Gory, Paul Stracke, Constantin Hecker, Gaultier Marnat, Hamza Shaikh, Christoph J. Griessenauer, David S. Liebeskind, Alessandro Pedicelli, Andrea Maria Alexandre, Illario Tancredi, Erwah Kalsoum, Boris Lubicz, Aman B. Patel, Vitor Mendes Pereira, Max Wintermark, Adrien Guenego, Adam A. Dmytriw, MAD-MT Investigators 
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520 |a Background Isolated anterior cerebral artery occlusions (ACAo) in patients with acute ischemic stroke present significant challenges due to their rarity. The efficacy and safety of endovascular therapy (EVT) in comparison with best medical therapy (BMT) for ACAo remains unclear. This study aimed to assess the outcomes of these treatments. - Methods This multinational, multicenter study analyzed data from the MAD-MT registry. Data were collected retrospectively from 37 sites across North America, Asia, and Europe. Inverse probability of treatment weighting (IPTW) was applied to balance confounding variables. The primary outcome was functional independence (modified Rankin Scale (mRS) scores of 0-2) at 90 days. Secondary outcomes included excellent outcomes (mRS 0-1), mortality at 90 days, and NIH Stroke Scale (NIHSS) score on day 1 post treatment. - Results Of the 108 patients, 36 received BMT and 72 underwent EVT. The median age was 75 years, and 56% were male. At 90 days, 40% of patients achieved mRS 0-2, with no significant difference between EVT and BMT (38% vs 45%, p=0.46). Procedural success (mTICI 2b-3) was 91% in the EVT group, with a sICH rate of 2.9%. IPTW-adjusted analysis showed no significant difference between EVT and BMT for functional independence (OR 1.17, 95% CI 0.23 to 6.02, p=0.85), mortality (25% vs 21%, p=0.71) or day 1 NIHSS scores (Beta 2.2, 95% CI −0.51 to 4.8, p=0.11). - Conclusions EVT showed high procedural success but did not significantly improve functional outcomes or mortality compared with BMT in patients with ACAo. Further randomized trials are needed to clarify EVT’s role in ACAo. 
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