Comment “Clinical Study of Symptomatic Nonacute Intracranial Large Arterial Occlusion with Endovascular Recanalization”

The publication “Clinical Study of Symptomatic Nonacute Intracranial Large Arterial Occlusion with Endovascular Recanalization”[1] is on a study that looked at the findings from a clinical trial of endovascular treatment for asymptomatic acute intracranial large artery occlusion (NA-ILAO). A total of 40 patients were enrolled, 36 of whom had effective revascularization. They were divided into two treatment groups: 24 got balloon angioplasty and 12 underwent stenting. The study looked at perioperative complications and clinical outcomes and had a median follow-up of 14 months. The stent group had a greater perioperative complication rate than the non-stent group, and the two groups had different rates of re-occlusion and recurrent stroke. However, clinical outcomes as determined by the modified Rankin scale showed no meaningful difference.

A significant flaw in the study methodology is the limited sample size, notably in the stent group (n = 12), which may restrict statistical power and generalizability. Furthermore, the study only included cases from a single center, which reduced the variety and heterogeneity of patient demographics and treatment circumstances. Furthermore, the inclusion criteria for enrollment may have added bias, as it is unclear how individuals with NA-ILAO of varying severity were identified and chosen for therapy. Furthermore, the lack of defined protocols for assessing long-term quality of life and functional results complicates determining therapy efficacy beyond 90-day clinical outcomes.

Future studies should aim to include larger multicenter designs to increase patient diversity and allow for greater generalizability. Increasing sample sizes, particularly in subgroups such as stent placement, will provide more robust data on clinical efficacy and safety. In addition, using standardized protocols for assessing immediate and long-term outcomes, including patient-reported quality of life measures, will provide a more comprehensive understanding of treatment effects. Furthermore, examining underlying factors leading to treatment failure or complications in specific patient populations may provide insights into optimizing patient selection for each intervention.

To bring novelty to further research, one possible approach could be to compare new stent technologies or to combine adjuvant therapies with traditional balloon dilatation and stent placement. Exploring the use of bioabsorbable or drug-eluting stents may provide an opportunity to reduce recurrence or reocclusion rates. In addition, the use of advanced imaging techniques and machine learning algorithms may help identify factors contributing to complications, allowing for the development of appropriate treatment strategies. Examining the role of patient-specific factors, such as genetics, comorbidities, and lifestyle, may also reveal avenues for personalized medicine in the vascular intervention field.

Declaration of GenAI use

The authors used language editing computational tool in preparation of the article.

Contributors' Statement

H.P.: 50% ideas, writing, analyzing, approval; V.W.: 50% ideas, supervision, approval.

Publikationsverlauf

Eingereicht: 04. September 2025

Angenommen: 07. September 2025

Artikel online veröffentlicht:
12. September 2025

• Reference

• 1 Dan B, Zhu B, Zeng W. et al. Clinical study of symptomatic nonacute intracranial large arterial occlusion with endovascular recanalization. J Neurol Surg B Skull Base 2023; 85 (05) 481-488