Endovascular interventions for acute ischemic stroke have been widely adopted on the basis of single-arm registries that reported high recanalization rates with limited complications.

     We conducted a retrospective cohort study comparing patients with clinically severe acute ischemic stroke treated with endovascular treatment versus standard medical therapy alone.

     At our stroke center over a 4-year period, 260 patients underwent endovascular treatment and 597 patients were treated with best medical therapy alone. All patients presented with a NIHSS score of <8 and were ineligible for IV tPA.

      Clinical outcomes at discharge and at 3 months were compared.

     Compared with the medical group, the endovascular group had a significantly greater proportion of patients who were discharged home (21.2% vs. 8.7%, p<0.001) and who could ambulate independently at discharge (32.1% vs. 16.8%, p<0.001). Of the patients with follow up, the proportion with a good outcome (mRS score of<2) at 3 months was also significantly higher in the endovascular group (51.9% vs. 35.7%, p<0.05). Conversely, the endovascular group had a significantly smaller proportion of patients discharged to a nursing home (11.9% vs 24.1%, p<0.001) and hospice (6.9% vs. 14.1%, p=0.003). Mortality rate at discharge was not different (21.2% vs. 18.9%, p=0.451). The rate of symptomatic ICH was 9.2% in the intervention group.

     This is a retrospective study.

     In our study, endovascular therapy provided a better functional outcome compared with standard medical therapy in select patients.

     Ultimately, the determination of efficacy of endovascular therapy for acute ischemic stroke compared with best medical therapy will depend on the results of randomized trials.