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Research Article: Association of endovascular treatment versus intravenous thrombolysis in mild stroke across occlusion subgroups

Date Published: 2026-10-14

Abstract:
The benefit of endovascular treatment (EVT) vs. intravenous thrombolysis (IVT) is uncertain in minor stroke patients (National Institutes of Health Stroke Scale [NIHSS]???5) with anterior large vessel occlusion (LVO). The pooled cohort consisted of patients with NIHSS ? 5 and internal carotid artery (ICA), M1 or M2 segment of the middle cerebral artery (MCA) from the DETECT2-China study and the Early antiplatelet for minor stroke following thrombolysis (EAST) trial. The primary efficacy outcome was excellent functional outcome, defined as a mRS 0–1 at 90?days. The primary safety outcome was symptomatic intracranial hemorrhage (sICH). Subgroup analyses were performed using interaction terms in logistic regression models to assess effect modification by baseline variable. To further explore the subgroup findings, analyses were repeated separately in patients with ICA/MCA-M1 occlusion and those with MCA-M2 occlusion. A total of 237 patients were enrolled, including 105 (44.3%) with the IVT group, 132 (55.7%) with the EVT group. Compared to the IVT group, the EVT group had a similar proportion of excellent functional outcome (73.5% vs. 75.2%, aOR?=?0.749, 95% CI?=?0.392–1.433, p =?0.383), a numerically higher proportion of sICH (1.9% vs. 6.1%, aOR?=?4.158, 95% CI?=?0.819–21.127, p =?0.086). Subgroup analysis revealed that a numerically increased odds of excellent functional outcome was found in patients with ICA or MCA-M1 occlusion who received EVT vs. IVT (79.4% vs. 67.2%, aOR?=?1.491, 95% CI: 0.693–3.211; p =?0.307), whereas significantly less probability of excellent functional outcome in those with MCA-M2 occlusion who received EVT vs. IVT (53.3% vs. 86.4%, aOR?=?0.250, 95% CI: 0.057–0.980, p =?0.050). A significant interaction effect was identified between treatment (EVT vs. IVT) and excellent functional outcome ( p for interaction?=?0.008). In this exploratory analysis, the association between reperfusion strategy and functional outcome differed according to occlusion site. Patients with proximal occlusions (ICA or MCA-M1) in the EVT cohort had numerically better outcomes, whereas those with M2 occlusions in the EVT cohort had worse outcomes compared with the IVT cohort.

Introduction:
The benefit of endovascular treatment (EVT) vs. intravenous thrombolysis (IVT) is uncertain in minor stroke patients (National Institutes of Health Stroke Scale [NIHSS]???5) with anterior large vessel occlusion (LVO).

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