Clinical outcome following best medical management in acute stroke with a proximal isolated occlusion of the anterior cerebral artery: an international multicentre study.

Poor functional outcome at 3 months was observed in nearly half of patients with isolated proximal ACA occlusion treated with best medical management alone.

• Poor functional outcome (mRS >2 at 3 months or failure to return to baseline mRS if pre-stroke mRS >2) occurred in 47 of 95 patients (49%).
• The study was retrospective and multicentre, including 23 centres in France and Switzerland.
• Patients were admitted within 6 hours of symptom onset and treated without endovascular therapy.
• Median age was 76 (IQR, 66–87) and median baseline NIHSS score was 10 (IQR, 5–15).

Older age was independently associated with poor functional outcome in multivariable logistic regression.

• Adjusted odds ratio per 5-year increase in age: aOR = 1.25; 95% CI, 1.10–1.55; P = .028.
• Age was evaluated as a continuous variable in the multivariable analysis.
• Median age of the cohort was 76 years (IQR, 66–87).

Higher baseline NIHSS score was independently associated with poor functional outcome.

• Adjusted odds ratio per 1-point NIHSS increase: aOR = 1.20; 95% CI, 1.07–1.34; P < .001.
• Median baseline NIHSS score in the cohort was 10 (IQR, 5–15).
• NIHSS was evaluated as a continuous variable in the multivariable logistic regression.

Lack of recanalisation at 24 hours was independently associated with poor functional outcome.

• Adjusted odds ratio for lack of recanalisation at 24 h: aOR = 14.5; 95% CI, 1.1–188.7; P = .04.
• This association was identified in multivariable analysis adjusting for baseline variables.
• The wide confidence interval reflects limited sample size for this subgroup analysis.

Haemorrhagic transformation was associated with poor outcome in univariable but not multivariable analysis.

• Poor outcome was higher in patients with haemorrhagic transformation compared to those without (73% vs 42%; P = .03) in univariable analysis.
• In multivariable analysis adjusting for age and NIHSS score, haemorrhagic transformation was not independently associated with poor outcome (aOR = 2.3; 95% CI, 0.5–11.5; P = .32).

The cohort consisted predominantly of A2 segment occlusions, with the majority of patients receiving intravenous thrombolysis.

• Occlusion site was A1 in 8 patients (8%) and A2 in 87 patients (92%).
• Intravenous thrombolysis was administered in 76 of 95 patients (80%).
• All patients were treated with best medical management alone, without endovascular therapy.
• A total of 95 patients were included across 23 centres in France and Switzerland.