Endovascular thrombectomy for subterminal internal carotid artery occlusions: clinical and radiological heterogeneity in a nationwide registry.

Authors

Emma Hall, Björn M Hansen, Alex Szolics, Teresa Ullberg, Johan Wassélius

Published in

Neuroradiology. Jul 14, 2026. Epub Jul 14, 2026.

Abstract

Subterminal intracranial Internal Carotid Artery (ICA-I) occlusion is a lesser-known stroke subtype which may delay access to endovascular thrombectomy (EVT). We compared clinical presentation, imaging characteristics, treatment delays, outcomes, and diagnostic accuracy between EVT-treated patients with ICA-I and carotid terminus (ICA-T) occlusions.
All EVT-treated patients with intracranial ICA occlusions registered in two Swedish national quality registers (2016-2022) were included. Outcomes included pre- and postoperative National Institutes of Health Stroke Scale (NIHSS), successful recanalization, and 90-day modified Rankin Scale. Perfusion images and original radiology reports from one comprehensive stroke center were analyzed to assess the relationship between collateral anatomical variants, stroke severity, perfusion deficits, and diagnostic accuracy.
Among 6163 EVT-treated patients, 356 had ICA-I occlusions and 657 had ICA-T occlusions. Median baseline NIHSS was lower in ICA-I occlusions (17 vs. 19), but variability in NIHSS and modified Alberta Stroke Program Early CT Score were higher (both p < 0.001). ICA-I occlusions were associated with EVT treatment delays, but recanalization rates, 24-hour NIHSS, and 90-day functional outcomes were similar between groups. In exploratory hypothesis-generating sub-group analyses of ICA-I occlusions, anterior collateral variants were associated with stroke severity, and fetal-type posterior cerebral artery variants were associated with larger perfusion deficits. In a sub-group analysis, ICA-I occlusions were correctly identified in 31% of baseline radiology reports compared with 57% of ICA-T occlusions.
ICA-I occlusions show greater clinical and radiological heterogeneity, are frequently underrecognized on baseline imaging, and are associated with longer treatment delays than ICA-T occlusions. Increased awareness may improve acute stroke triage and reduce delays to treatment.

PMID:
42446650
Bibliographic data and abstract were imported from PubMed on 14 Jul 2026.

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