Endovascular treatment and clinical outcomes in minor ischemic stroke due to large-vessel disease: a retrospective study
TL;DR
In patients with minor ischemic stroke caused by severe intracranial stenosis or occlusion, EVT was associated with more favorable early neurological and 90-day functional outcomes after adjustment for measured confounding.
Abstract
Background Patients with minor ischemic stroke may still experience early neurological deterioration when severe intracranial stenosis or occlusion is present. The optimal role of endovascular treatment (EVT) in this imaging-defined population remains uncertain. This study aimed to evaluate clinical outcomes associated with EVT and to explore prognostic factors in patients with minor ischemic stroke caused by major intracranial arterial disease. Methods This retrospective observational cohort study included consecutive adults with admission National Institutes of Health Stroke Scale (NIHSS) score ≤ 5 and severe intracranial stenosis or occlusion treated between January 2023 and December 2025. Patients were classified according to final treatment received as medical treatment or EVT, including direct and rescue EVT. The primary outcome was the full distribution of the 90-day modified Rankin Scale (mRS). Inverse probability of treatment weighting (IPTW), multivariable adjustment, and doubly robust analyses were used to address measured baseline imbalance. Results Among 218 included patients, 128 received medical treatment and 90 underwent EVT, including 56 direct EVT and 34 rescue EVT cases. The median 90-day mRS score was 2 in the medical group and 1 in the EVT group. EVT was associated with a favorable ordinal mRS shift in the IPTW-weighted model (common odds ratio [OR], 1.69; 95% confidence interval [CI], 1.02–2.80; P = 0.043), with consistent findings in multivariable and doubly robust models. EVT was also associated with higher odds of 90-day mRS 0–2 (IPTW OR, 1.72; 95% CI, 1.04–2.85; P = 0.035) and 48-h NIHSS 0–1 (IPTW OR, 2.21; 95% CI, 1.18–4.14; P = 0.013). Symptomatic intracranial hemorrhage occurred in 3.1% and 5.6% of patients, respectively (OR, 1.82; 95% CI, 0.48–6.99; P = 0.493). Better collateral status and initial ischemic penumbra were associated with favorable outcome. Conclusions In patients with minor ischemic stroke caused by severe intracranial stenosis or occlusion, EVT was associated with more favorable early neurological and 90-day functional outcomes after adjustment for measured confounding. Collateral status and ischemic penumbra may provide prognostic information, but their role in imaging-informed treatment selection requires prospective validation.