Endovascular treatment in patients with cervical or intracranial isolated internal carotid artery occlusion: A systematic review and meta-analysis.
Mariana Letícia de Bastos Maximiano, Ocilio Ribeiro Gonçalves, Luciano Falcão et al.
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In 30 seconds
This systematic review and meta-analysis compared endovascular treatment (EVT) with best medical treatment (BMT) for adults with acute ischemic stroke due to isolated internal carotid artery occlusion, including cervical and intracranial occlusions. Five studies included 1531 patients. EVT was not associated with a statistically significant improvement in 90-day functional independence (mRS 0–2; OR 1.78; 95% CI 0.99-3.21), and adjusted analyses showed a smaller, also nonsignificant association (OR 1.22; 95% CI 0.82-1.82). Mortality and symptomatic intracranial hemorrhage also did not differ significantly between treatment groups.
Key findings
- Across five studies and 1531 patients, EVT did not significantly improve 90-day functional independence versus BMT (OR 1.78; 95% CI 0.99-3.21; I 2 = 71%).
- Adjusted analyses attenuated the association with functional independence (OR 1.22; 95% CI 0.82-1.82).
- There were no significant group differences in 90-day mortality (OR 0.84; 95% CI 0.64-1.09) or symptomatic intracranial hemorrhage (OR 1.48; 95% CI 0.72-3.07).
- Subgroup analyses by cervical versus intracranial occlusion showed similar neutral results, although a benefit for intracranial occlusions could not be excluded.
Why it matters
Patients with isolated internal carotid artery occlusion were largely excluded from pivotal thrombectomy trials, leaving uncertainty about the role of EVT. This synthesis finds no demonstrated superiority over medical treatment for functional outcome, mortality, or symptomatic hemorrhage. It helps define the current evidence gap while underscoring that treatment effects, particularly by occlusion site, remain uncertain.
What to keep in mind
The evidence came from five studies, and EVT patients were younger and had more severe strokes. The pooled functional-independence analysis had substantial heterogeneity (I 2 = 71%); the findings are observational and hypothesis-generating.