ENDOVASCULAR thrombectomy (EVT) and best medical treatment are both effective and safe options for treating acute extracranial internal carotid artery (ICA) occlusions, according to a study published this month.
The research analysed data from 354 patients across 22 stroke centres in Europe and Asia. It compared outcomes between EVT, a minimally invasive surgical procedure, and standard medical care, which often includes intravenous thrombolysis.
The study is significant as acute ICA occlusions below the circle of Willis, a junction of arteries near the hypothalamus, are particularly challenging to treat. These blockages can cause a range of stroke symptoms, even when major intracranial arteries remain unaffected.
The team found that both EVT and best medical treatment resulted in similar rates of favourable functional outcomes. EVT achieved complete recanalisation in 80.9% of cases but was associated with periprocedural distal embolisation in 27.8% of patients, which negatively impacted outcomes. Despite this, the rates of symptomatic intracerebral haemorrhages and long-term mortality were comparable between the two approaches.
“Both endovascular and best medical treatment were effective and safe options for symptomatic acute ICA occlusions,” the authors concluded.
However, the researchers acknowledged limitations, including an imbalance in the number of patients between treatment groups. Larger studies are needed to establish optimal patient selection criteria and fully understand EVT’s benefits and risks.
Experts in the field have highlighted the value of such research, noting the scarcity of research on acute extracranial ICA occlusions. While EVT shows promise, authors cautioned against the risks of distal embolisation and reperfusion injury.
Further large-scale studies, the editorial urged, are critical to refining treatment strategies and improving outcomes for these complex cases.
This research offers new hope for stroke patients, supporting EVT as a viable alternative or complement to traditional medical care.
Victoria Antoniou, EMJ
Reference
Meyer L et al. Endovascular versus Best Medical Treatment for Acute Carotid Occlusion BelOw Circle of Willis (ACOBOW): The ACOBOW Study. Radiology. 2025;314(1):e240293.
