2025 American Academy of Neurology Abstract Website

Objective:

To compare the clinical outcomes of endovascular thrombectomy in patients with intracranial atherosclerosis-related occlusions (ICAS) versus non-ICAS occlusions, focusing on mortality, functional independence, recanalization, reperfusion, and symptomatic intracranial hemorrhage (sICH).

Background:

ICAS and non-ICAS occlusions have distinct pathophysiological mechanisms, influencing treatment choices and thrombectomy outcomes for both groups. ICAS-related occlusions (ICAS-O) often pose procedural challenges, including a higher risk of intraprocedural occlusion and the frequent need for rescue strategies. This systematic review and meta-analysis aimed to compare the outcomes of thrombectomy in patients with ICAS versus non-ICAS occlusions.

Design/Methods:

We conducted a systematic search of multiple databases (Pubmed, Cochrane, ScienceDirect, and Embase) to identify studies reporting thrombectomy outcomes between ICAS and non-ICAS patients. Random-effects meta-analyses were performed via Comprehensive Meta-Analysis (CMA) version 3.0 to assess mortality, functional independence (mRS 0-2), recanalization, reperfusion, and symptomatic intracranial hemorrhage (sICH).

Results:

1,810 participants from 17 studies were analyzed, with 979 in the ICAS group and 831 in the non-ICAS group. The mean age and baseline NIHSS scores were similar between groups. Hypertension was the most prevalent risk factor in both groups. Forest plot analysis revealed no significant difference in mortality between ICAS and non-ICAS groups (OR=1.150, 95% CI: 0.717-1.843, p=0.562), with moderate heterogeneity (I²=59%). ICAS patients had a slightly higher but non-significant chance of functional independence (OR=1.206, 95% CI: 0.877–1.660, p=0.249, I2=50%). Recanalization rates were marginally higher but non-significant in ICAS patients (OR=0.919, 95% CI: 0.284–2.977, p=0.889), though heterogeneity was substantial. Reperfusion and sICH outcomes showed no significant differences.

Conclusions:

Thrombectomy outcomes in ICAS and non-ICAS patients are largely comparable, suggesting that current thrombectomy practices remain an effective treatment for ICAS. However, variability and high heterogeneity in study results highlight the need for more standardized procedural approaches.