Endovascular Therapy Versus Medical Therapy for Acute Stroke Attributable to Isolated Cervical Internal Carotid Artery Occlusion Without Intracranial Large Vessel Occlusion.

Background: The optimal treatment for acute stroke attributable to isolated cervical internal carotid artery occlusion without intracranial target is unclear. The purpose of our study was to examine whether endovascular therapy for acute stroke attributable to isolated cervical internal carotid artery occlusion was associated with improved clinical outcome. Methods: We identified patients from 2 comprehensive stroke centers during the period January 2009 to December 2019, with acute ischemic stroke attributable to cervical internal carotid artery occlusion without an intracranial occlusion. We categorized patients into 2 groups: endovascular therapy and medical therapy. Clinical outcome (modified Rankin scale score at 90 days poststroke) was compared between the 2 groups. Results: Seventy-three patients were included (26 women [36%]; median age, 69 [interquartile range (IQR), 60-80] years; median National Institutes of Health Stroke Scale score, 11 [IQR, 5-16]). Of these, 40 patients received endovascular therapy, and 33 patients were managed with medical therapy alone. The endovascular therapy group had a significantly higher median National Institutes of Health Stroke Scale score on presentation (13 versus 3; Conclusions: Endovascular therapy in isolated cervical internal carotid artery occlusion may be associated with improved outcome when compared with medical therapy. However, the significant differences in baseline characteristics between the groups limit interpretation. Randomized controlled trials are necessary.