Endovascular treatment versus best medical treatment for acute anterior cerebral artery occlusion: a single-center inverse probability of treatment-weighted cohort study

Introduction Evidence regarding the benefit of endovascular treatment (EVT) for isolated acute anterior cerebral artery occlusion remains limited. We aimed to compare the efficacy and safety of EVT versus best medical treatment (BMT) in this population. Methods We retrospectively screened consecutive patients with acute anterior cerebral artery occlusion between May 2020 and October 2025. The primary outcome was excellent functional outcome, defined as a 90-day modified Rankin Scale (mRS) score of 0–1. Secondary outcomes included 90-day mRS 0–2, mRS 0–3, mortality, symptomatic intracranial hemorrhage (sICH), and any intracranial hemorrhage (any ICH). Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were used to adjust for baseline differences. Results Among 69 included patients, 37 received BMT and 32 underwent EVT. Successful reperfusion was achieved in 27 of 32 patients treated with EVT (84.4%). The primary outcome of 90-day mRS 0–1 occurred in 17 of 37 patients (45.9%) in the BMT group and 13 of 32 patients (40.6%) in the EVT group. EVT was not significantly associated with 90-day mRS 0–1 after adjustment (adjusted odds ratio [OR], 1.74; 95% confidence interval [CI], 0.50–5.99). No significant differences were observed for 90-day mRS 0–2, mRS 0–3, mortality, sICH, or any ICH. IPTW-adjusted sensitivity analyses yielded consistent results. Conclusion EVT showed high reperfusion success but was not associated with a statistically significant improvement in 90-day functional outcomes compared with BMT. Further multicenter studies are needed to clarify the potential role of EVT in this population.