ABSTRACT NUMBER: ESOC2026A2187 ENDOVASCULAR THERAPY VS MEDICAL THERAPY FOR ACUTE STROKE DUE TO ISOLATED OCCLUSION OF THE CERVICAL INTERNAL CAROTID ARTERY WITHOUT OCCLUSION OF LARGE INTRACRANIAL VESSELS

Abstract Background and aims The optimal treatment for acute stroke secondary to isolated cervical internal carotid artery occlusion (ICAO) lacks evidence from clinical trials. Our objective was to evaluate the use of reperfusion therapies in patients with this condition. Methods Prospective study of patients with ICAO from the NORDICTUS registry in Spain (11 centers), period 30/11/2017 to 16/01/2023. They were classified according to the therapeutic option endovascular thrombectomy Vs intravenous fibrinolysis (EVT/ IVT) and the severity of the deficit (NIHss admission ≥6). Results Sixty-four patients (median age 73 years) were included: 40 received EVT (10 combined with IVT) and 24 received IVT alone. Patients receiving EVT had a higher deficit than the IVT group (NIHss admission) [18 (12-19) vs. 6.5 (4.25-12), p<0.001]. Symptomatic bleeding and mortality rates were 6.3% and 20.3%, respectively. The IVT group had a better prognosis (mR ≤2) than the EVT group (62.5% vs. 37.5%; p=0.093). In the analysis according to NIHss ≥6, no differences were found between IVT (n=13) and EVT (n=38) [mR ≤2 53.8% vs. 34.2%; OR 1.5 (0.8-3.0), p=0.35]. In the EVT group, procedure time [(mR≤2: median 40 minutes (30-84) vs mR>2: 90 (39-125); p=0.046] and collateral grade were significantly associated with better outcome [(grade >50%, mR≤2 60.9%; vs grade <50%, mR≤2 0%; p=0.041)]. Conclusions In patients with ICAO, medical treatment offers better results than EVT, although patient selection varies depending on the initial severity of the stroke. Procedure time and collateral damage are variables that influence the outcome of EVT. Conflict of interest No author has anything to declare