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Updated: Jan 24, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular Stenting for Acute Ischemic Stroke Due to Cervical Artery Dissection: Nationwide Study of Stroke
Huanwen Chen1, Mihir Khunte2,3, Marco Colasurdo4
1Division of Neurointerventional Surgery, Department of Neurosurgery University of Maryland Medical Center Baltimore MD.
Insights
Endovascular stenting for acute ischemic stroke (AIS) due to cervical artery dissection (CAD) significantly reduced stroke recurrence within 180 days. While stenting increased intracranial hemorrhage risk, it did not impact short-term mortality or discharge outcomes.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Cardiology
Background:
- Cervical artery dissection (CAD) can cause acute ischemic stroke (AIS).
- Endovascular stenting is used for severe stenosis or occlusion in AIS-CAD.
- Previous studies showed mixed outcomes for stenting versus no stenting in AIS-CAD, with no data on stroke recurrence.
Purpose of the Study:
- To investigate the association between endovascular stenting and stroke recurrence in patients with AIS-CAD.
- To evaluate the impact of stenting on short-term outcomes during the index hospitalization for AIS-CAD.
Main Methods:
- Retrospective cohort study using the 2016-2021 Nationwide Readmissions Database.
- Included adult patients hospitalized for AIS-CAD.
- Propensity score matching was used to compare patients who underwent stenting versus those who did not, controlling for demographics, stroke severity, and comorbidities.
Main Results:
- The stenting group (2244 patients) had a significantly lower risk of recurrent ischemic stroke within 180 days compared to the no-stenting group (2215 patients) (HR 0.50; P=0.034).
- The 180-day recurrent stroke rate was 1.2% with stenting versus 3.5% without (P=0.017).
- Stenting was associated with a higher rate of intracranial hemorrhage (21.9% vs 19.0%; P=0.027) but not with differences in routine discharge or death rates.
Conclusions:
- Endovascular stenting is associated with a reduced risk of stroke recurrence in patients with AIS-CAD.
- Despite an increased risk of intracranial hemorrhage, stenting did not lead to worse short-term morbidity or mortality outcomes.
- Stenting may be a beneficial treatment option for select patients with AIS-CAD to prevent recurrent strokes.
Background:
For patients with acute ischemic stroke (AIS) due to cervical artery dissection (CAD), endovascular stenting can improve and maintain vessel patency for severely stenotic or occlusive lesions. Athough prior reports have suggested equivocal functional outcomes with stenting versus no stenting for AIS-CAD, there are currently no data on stenting and stroke recurrence.
Methods:
This was a retrospective cohort study of the 2016-21 Nationwide Readmissions Database in the United States. Adult patients hospitalized for AIS-CAD were included. Patients who did and did not undergo endovascular stenting were matched using propensity scores calculated using logistic regression models accounting for demographics, stroke severity, and comorbidities. The primary end point was recurrent ischemic stroke within 180 days. Secondary end points include outcomes of the index AIS-CAD hospitalization such as routine discharge to home without rehabilitation needs, death, and intracranial hemorrhage.
Results:
A total of 20 434 patients were included; 2368 (11.6%) underwent endovascular stenting. After propensity score matching, 2215 patients remained in the no stenting group, and 2244 remained in the stenting group. The stenting group had a significantly lower stroke recurrence risk than the no-stenting group within 180 days (hazard ratio 0.50 [95% CI: 0.27-0.95], P = 0.034). Among patients with at least 180 days of follow-up, the rate of recurrent stroke was 1.2% in the stenting group, which was significantly lower than 3.5% in the no-stenting group (P = 0.017). During the index AIS-CAD hospitalization, stenting was not associated with a different rate of routine discharge (43.8% versus 44.8%, P = 0.65) or death (8.7% versus 7.3%, P = 0.34); however, it was associated with a higher rate of intracranial hemorrhage (21.9% versus 19.0%, P = 0.027).
Conclusion:
For patients with AIS-CAD, endovascular stenting was associated with a lower rate of stroke recurrence. Although stenting was associated with a higher rate of intracranial hemorrhage, this phenomenon did not culminate in different rates of short-term morbidity or mortality.
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