Highlights
1. EVT significantly improves 90-day modified Rankin Scale scores and functional independence in ACAo stroke patients.
2. No increased risk of symptomatic intracranial hemorrhage or mortality with EVT versus standard medical management.
3. Benefits are pronounced in patients with baseline NIH Stroke Scale scores ≥6.
Background
Acute ischemic stroke due to anterior cerebral artery occlusion (ACAo) presents a significant clinical challenge, with limited evidence guiding treatment decisions. While endovascular thrombectomy (EVT) has proven efficacy in proximal large vessel occlusions, its role in ACAo remains understudied. The ORIENTAL-MeVO Registry provides critical insights into this gap, comparing EVT with standard medical management (SMM) in a multicenter Chinese cohort.
Study Design
This retrospective study analyzed 343 patients with ACAo (A1/A2/A3 segments) within 24 hours of symptom onset across 25 centers from September 2019 to September 2024. Inclusion criteria included confirmed ACAo via imaging, prestroke mRS ≤2, and exclusive EVT or SMM treatment. Propensity score matching and inverse probability of treatment weighting adjusted for baseline confounders.
Key Findings
EVT showed statistically superior 90-day mRS distribution (aOR 2.14, 95% CI 1.59-2.89), excellent functional outcome (aRR 1.77, 95% CI 1.27-2.48), and functional independence (aRR 2.35, 95% CI 1.63-3.39) versus SMM. Safety outcomes were comparable between groups. Subgroup analyses identified greater benefit in patients with NIHSS ≥6.
Conclusion
The ORIENTAL-MeVO Registry demonstrates EVT’s efficacy for ACAo stroke, particularly in moderate-severe cases, supporting its consideration in clinical practice while awaiting randomized trial validation.