Outcome Comparison of Endovascular Treatment for Acute Large Vessel Occlusion Due to Large Artery Atherosclerosis and Cardioembolism in the Chinese Population: Data from the ANGEL Registry

Abstract

Background and Purpose

Studies on outcome comparison after endovascular treatment (EVT) for large vessel occlusion (LVO) between large artery atherosclerosis (LAA) and cardioembolism (CE) in the Asian population are scarce. We aimed to compare the baseline characteristics and clinical outcomes after EVT for anterior circulation LVO with LAA and CE in the Chinese population.

Methods

Patients were selected from the ANGEL registry and divided into LAA and CE groups. The primary outcome was the 90-day modified Rankin Scale (mRS) 0–2. The secondary outcomes were 90-day mRS distribution, 90-day mRS 0–1, 90-day mRS 0–3, and early neurological improvement. The safety outcomes included death, symptomatic intracranial hemorrhage, and any intracranial hemorrhage. We conducted logistic regression models with adjustments to compare the outcomes.

Results

A total of 632 patients were included, of whom, 488 were in the LAA group and 144 were in the CE group. No significant difference in 90-day mRS 0–2 was observed between LAA and CE groups (55.7%vs.43.1%, odds ratio[OR] 1.19, 95% confidence interval(CI), 0.92–1.53, P=0.190). The LAA group exhibited a higher frequency of mRS 0–3 compared to the CE group (69.1% vs 32.6%, OR1.32, 95% CI 1.02–1.72, P=0.038). However, the incidence of death within 90 days did not significantly differ between the LAA and CE groups (10.9%vs.24.3%, OR0.91, 95% CI0.66–1.25, P=0.545), nor did the occurrences of symptomatic intracranial hemorrhage(SICH) (4.5%vs.9.7%,OR1.08, 95% CI 0.65–1.78, P=0.779) or intracranial hemorrhage(ICH) (21.9%vs.30.6%, OR 0.94, 95% CI0.71–1.25, P=0.680). Moreover, no significant disparities were detected in other outcomes between the two groups (All P>0.05).

Conclusion

In the ANGEL registry, a higher prevalence of patients undergoing EVT for acute anterior circulation LVO with LAA was found than those with CE. However, our study revealed that the efficacy and safety of EVT remained consistent regardless of the stroke’s etiology such as LAA or CE.

Keywords:

• large vessel occlusion
• endovascular treatment
• large artery atherosclerosis
• cardioembolism

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethics Approval and Consent to Participate

The study was performed in accordance with the guidelines of the 1964 Declaration of Helsinki and was approved by the ethics committees of all participating centers. Subjects or their legally authorized representatives provided written informed consent prior to commencing the study.

Acknowledgments

We thank all clinicians, statisticians, and imaging and laboratory technologists who were involved in the ANGEL registry. Dr. Huo moved to Beijing Anzhen Hospital, Capital Medical University from Beijing Tiantan Hospital, Capital Medical University in 2023.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.

Disclosure

All authors report no conflicts of interest in this work.

Additional information

Funding

There is no funding to report.