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

Guangcai Shao,1 Xiang Li,2 Meiyue Da,1 Xiaochuan Huo,3 Shuheng Zhang1 1Department of Neurosurgery, Anshan Central Hospital, Anshan, People’s Republic of China; 2Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China; 3Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Shuheng Zhang, Department of Neurosurgery, Anshan Central Hospital, No. 77 South Zhonghua Road, Tiedong District, Anshan, 114009, People’s Republic of China, Tel +8618804120515, Email 1223443553@qq.com Xiaochuan Huo, Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China, Email huoxiaochuan@126.comBackground 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