Thrombectomy Versus Medical Management in Mild Large Vessel Occlusion Stroke: A Multicenter Cohort with One-Year...

Evidence regarding the long-term outcomes of patients with mild large vessel occlusion (LVO) stroke remains limited. This study aimed to compare 12-month outcomes between acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT) versus best medical management (BMM).

A multicenter, retrospective study across three centers was conducted, including AIS patients with LVO and National Institutes of Health Stroke Scale score (NIHSS) <6 between January 2019 and December 2023. Patients were categorized into EVT or BMM groups according to initial treatment strategy. The primary outcome was functional independence (modified Rankin Scale score of 0-2) at 12 months. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to adjust for potential confounders.

A total of 976 patients with LVO were screened, and 285 with NIHSS <6 were enrolled. After IPTW adjustment (195 EVT vs. 201 BMM), functional independence was achieved in 78.5% of EVT and 74.1% of BMM patients (adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.70-2.20) at 12 months. Hemorrhagic transformation was more frequent in the EVT group (13.3% vs. 5.5%; aOR 2.63, 95% CI 1.20-5.85), whereas symptomatic intracranial hemorrhage rates were similar between groups. Notably, stroke recurrence within 12 months was significantly lower in the EVT group compared to the BMM group (4.6% vs. 12.9%; aOR 0.33, 95% CI 0.15-0.70).

In patients with mild LVO, no statistically significant difference in long-term functional outcomes was observed between EVT and BMM, although EVT was associated with a lower risk of stroke recurrence.