# Clinical outcome following best medical management in acute stroke with a proximal isolated occlusion of the anterior cerebral artery: an international multicentre study

## TL;DR

This study finds that nearly half of stroke patients with a specific type of brain artery blockage have poor recovery when treated only with standard medical care.

## Contribution

The study provides new insights into clinical outcomes and predictors of poor recovery in acute stroke patients with proximal ACA occlusions managed medically.

## Key findings

- Poor functional outcome was observed in 49% of patients with proximal ACA occlusions treated medically.
- Older age and higher NIHSS scores at admission were independently associated with poor outcomes.
- Lack of recanalisation at 24 hours was strongly linked to poor functional outcomes.

## Abstract

Acute ischaemic strokes (AIS) due to proximal anterior cerebral artery (ACA) occlusions are rare. Their clinical outcomes following medical management alone have been scarcely described.

We conducted a retrospective, multicentre, international study of consecutive AIS due to isolated proximal ACA occlusion (A1 or A2 segment) admitted within 6 h of symptom onset and treated with best medical management alone (ie, without endovascular therapy), across 23 centres in France and Switzerland. The primary outcome was poor functional outcome, defined as a mRS score > 2 at 3 months or failure to return to baseline mRS if the pre-stroke mRS was > 2. Associations between baseline clinical/radiological variables and outcome were evaluated in multivariable logistic regression analyses. Associations between outcome and key radiological follow-up variables such as recanalisation and haemorrhagic transformation were also analysed.

Ninety-five patients were included in the study: median age was 76 (IQR, 66–87), baseline NIHSS score was 10 (IQR, 5–15) and occlusion site was A1 in 8 (8%) and A2 in 87 (92%). Intravenous thrombolysis was administered in 76 (80%) cases. Poor functional outcome was observed in 47 (49%) patients. Among baseline variables, older age (adjusted odds ratio [aOR] per 5-year increase = 1.25; 95% CI, 1.10–1.55; P = .028) and higher NIHSS score (aOR = 1.20, 95% CI, 1.07–1.34; P < .001) were independently associated with poor outcome. Lack of recanalisation at 24 h was also independently associated with poor outcome (aOR = 14.5, 95% CI, 1.1–188.7, P = .04). Poor outcome was higher in patients with than in those without haemorrhagic transformation (73% vs 42%, P = .03) in univariable analysis, but not in multivariable analysis adjusting for age and NIHSS score (aOR = 2.3, 95% CI, 0.5–11.5, P = .32).

Nearly half of AIS patients with isolated proximal ACA occlusion treated with medical management alone had poor 3-month functional outcomes. Older age, high NIHSS at admission and lack of recanalisation at 24 h were associated with poor outcome. These results underscore the need to investigate therapeutic strategies aimed at enhancing early arterial recanalisation to improve recovery in this population.

Graphical Abstract