Association of endovascular treatment versus intravenous thrombolysis in mild stroke across occlusion subgroups
- 1Department of Neurology, General Hospital of Northern Theater Command
- 2Department of Graduate School, Dalian Medical University
Abstract
Background: The benefit of endovascular treatment (EVT) vs. intravenous thrombolysis (IVT) is uncertain in minor stroke patients (National Institutes of Health Stroke Scale [NIHSS] ≤ 5) with anterior large vessel occlusion (LVO).
Methods: The pooled cohort consisted of patients with NIHSS ≤ 5 and internal carotid artery (ICA), M1 or M2 segment of the middle cerebral artery (MCA) from the DETECT2-China study and the Early antiplatelet for minor stroke following thrombolysis (EAST) trial. The primary efficacy outcome was excellent functional outcome, defined as a mRS 0–1 at 90 days. The primary safety outcome was symptomatic intracranial hemorrhage (sICH). Subgroup analyses were performed using interaction terms in logistic regression models to assess effect modification by baseline variable. To further explore the subgroup findings, analyses were repeated separately in patients with ICA/MCA-M1 occlusion and those with MCA-M2 occlusion.
Results: A total of 237 patients were enrolled, including 105 (44.3%) with the IVT group, 132 (55.7%) with the EVT group. Compared to the IVT group, the EVT group had a similar proportion of excellent functional outcome (73.5% vs. 75.2%, aOR = 0.749, 95% CI = 0.392–1.433, p = 0.383), a numerically higher proportion of sICH (1.9% vs. 6.1%, aOR = 4.158, 95% CI = 0.819–21.127, p = 0.086). Subgroup analysis revealed that a numerically increased odds of excellent functional outcome was found in patients with ICA or MCA-M1 occlusion who received EVT vs. IVT (79.4% vs. 67.2%, aOR = 1.491, 95% CI: 0.693–3.211; p = 0.307), whereas significantly less probability of excellent functional outcome in those with MCA-M2 occlusion who received EVT vs. IVT (53.3% vs. 86.4%, aOR = 0.250, 95% CI: 0.057–0.980, p = 0.050). A significant interaction effect was identified between treatment (EVT vs. IVT) and excellent functional outcome ( p for interaction = 0.008).
Conclusion: In this exploratory analysis, the association between reperfusion strategy and functional outcome differed according to occlusion site. Patients with proximal occlusions (ICA or MCA-M1) in the EVT cohort had numerically better outcomes, whereas those with M2 occlusions in the EVT cohort had worse outcomes compared with the IVT cohort.
Related
- Intra‐Arterial Alteplase After Successful Endovascular Reperfusion in Patients Without Intravenous Thrombolysis: A Subgroup Analysis of the PEARL Randomized Clinical Trial
- Extending the Treatment Window for Intravenous Thrombolysis in Acute Ischemic Stroke
- The ipsilesional DTI-ALPS index provides modest incremental prognostic value beyond clinical models for 90-day outcome in patients with acute MCA occlusion treated with intravenous thrombolysis: a prospective exploratory cohort study
- Association of the remnant cholesterol inflammation index with long-term outcomes among patients with acute ischemic stroke treated with intravenous thrombolysis
- Endovascular treatment versus best medical treatment for acute anterior cerebral artery occlusion: a single-center inverse probability of treatment-weighted cohort study.
BibTeX
@article{xing2026association,
title = {{Association of endovascular treatment versus intravenous thrombolysis in mild stroke across occlusion subgroups}},
author = {Gao-Peng Xing and Xiao-Long Li and Ting-Ting Wang and Hui-Sheng Chen},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1878069},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1878069/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association of endovascular treatment versus intravenous thrombolysis in mild stroke across occlusion subgroups
AU - Gao-Peng Xing
AU - Xiao-Long Li
AU - Ting-Ting Wang
AU - Hui-Sheng Chen
PY - 2026
DA - 2026/10/14
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1878069
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1878069/full
AB - Background: The benefit of endovascular treatment (EVT) vs. intravenous thrombolysis (IVT) is uncertain in minor stroke patients (National Institutes of Health Stroke Scale [NIHSS] ≤ 5) with anterior large vessel occlusion (LVO). Methods: The pooled cohort consisted of patients with NIHSS ≤ 5 and internal carotid artery (ICA), M1 or M2 segment of the middle cerebral artery (MCA) from the DETECT2-China study and the Early antiplatelet for minor stroke following thrombolysis (EAST) trial. The primary efficacy outcome was excellent functional outcome, defined as a mRS 0–1 at 90 days. The primary safety outcome was symptomatic intracranial hemorrhage (sICH). Subgroup analyses were performed using interaction terms in logistic regression models to assess effect modification by baseline variable. To further explore the subgroup findings, analyses were repeated separately in patients with ICA/MCA-M1 occlusion and those with MCA-M2 occlusion. Results: A total of 237 patients were enrolled, including 105 (44.3%) with the IVT group, 132 (55.7%) with the EVT group. Compared to the IVT group, the EVT group had a similar proportion of excellent functional outcome (73.5% vs. 75.2%, aOR = 0.749, 95% CI = 0.392–1.433, p = 0.383), a numerically higher proportion of sICH (1.9% vs. 6.1%, aOR = 4.158, 95% CI = 0.819–21.127, p = 0.086). Subgroup analysis revealed that a numerically increased odds of excellent functional outcome was found in patients with ICA or MCA-M1 occlusion who received EVT vs. IVT (79.4% vs. 67.2%, aOR = 1.491, 95% CI: 0.693–3.211; p = 0.307), whereas significantly less probability of excellent functional outcome in those with MCA-M2 occlusion who received EVT vs. IVT (53.3% vs. 86.4%, aOR = 0.250, 95% CI: 0.057–0.980, p = 0.050). A significant interaction effect was identified between treatment (EVT vs. IVT) and excellent functional outcome ( p for interaction = 0.008). Conclusion: In this exploratory analysis, the association between reperfusion strategy and functional outcome differed according to occlusion site. Patients with proximal occlusions (ICA or MCA-M1) in the EVT cohort had numerically better outcomes, whereas those with M2 occlusions in the EVT cohort had worse outcomes compared with the IVT cohort.
SN - 1664-2295
ER -