Abstract

Background: Acute ischemic stroke due to M1 middle cerebral artery (MCA) occlusion with underlying intracranial atherosclerotic stenosis (ICAS) presents unique therapeutic challenges. We investigated the safety and efficacy of endovascular intervention in this complex clinical scenario.

Methods: This prospective cohort study enrolled 27 patients with acute M1 occlusion and underlying chronic stenosis treated at Hue Central Hospital Stroke Center from November 2023 to January 2025. Primary endpoints included successful recanalization (mTICI ≥2b) and functional independence (mRS 0-2) at 3 months.

Results: Mean age was 62±9 years with 55.6% male predominance. All patients underwent stent-retriever thrombectomy with 81.5% requiring rescue balloon angioplasty and 37.0% requiring stent placement. Complete recanalization (mTICI 3) was achieved in 74.1% of patients. At 3-month follow-up, 63.0% achieved functional independence with no mortality observed.

Conclusions: Endovascular intervention for M1 occlusion with underlying stenosis demonstrates acceptable safety and efficacy profiles. The combined approach of thrombectomy followed by rescue angioplasty and selective stenting provides favorable clinical outcomes in carefully selected patients.