Effects of Manual Carotid Compression in Endovascular Thrombectomy for Acute Anterior Circulation Large-vessel Occlusion: A Multicenter, Propensity Score-Matching Study

Li BaoShuang He^*

• Department of stroke center, Affiliated Hospital of Nantong University, Nantong, China

Background: Randomized controlled trials suggested that balloon guide catheters for proximal flow control (PFC) in endovascular thrombectomy (EVT) for acute anterior circulation large-vessel occlusion (LVO) have unsatisfactory results. Our study aimed to explore effects of manual carotid compression (MCC) achieving temporary PFC in EVT, without interfering with endovascular procedures. Methods: We retrospectively included 203 patients with acute occlusion of the intracranial internal carotid artery or the M1 or proximal M2 segments of the middle cerebral artery undergoing EVT from three independent centers (n=80 in the MCC group and n=123 in the non-MCC group). The primary outcome was the 90-day functional independence, defined as a modified Rankin Scale (mRS) score≤2. Propensity score matching (PSM) analysis was conducted to compare outcomes. Results: In the overall cohort, the median age was 71 years (IQR 62-76), with 119 male patients (58.6%). Baseline characteristics between the two groups differed significantly in terms of hypertension (p=0.017), previous stroke/TIA (p=0.01), pre-stroke mRS (p=0.003), baseline National Institutes of Health Stroke Scale (NHISS) score(p=0.004), left occlusion (p<0.001), and transfemoral access (p=0.009). After adjusting for baseline characteristics using PSM, 34 matched pairs were analyzed. There was no significant difference in the 90-day functional independence between the two groups (44.1% vs 32.4%, p=0.454). The MCC group showed significantly lower mRS scores at 90 days (p=0.031), with a higher proportion of patients scoring 0-1 (41.2% vs 8.8%, p=0.005). MCC significantly increased the first pass effect (FPE) rate (55.9% vs 23.5%,p=0.013) and the rate of modified Thrombolysis in Cerebral Infarction score ≥ 2b after the first pass (70.6% vs 41.2%, p=0.028), and reduced NHISS scores at 24 hours after recanalization (p=0.002) and at 7 days or discharge (p<0.001). In terms of safety outcomes, MCC effectively reduced the incidence of intracranial hemorrhage (ICH) (14.7% vs 47.1%, p=0.009) and symptomatic ICH (sICH) (0% vs 17.6%, p=0.033). Conclusion：MCC in EVT for patients with acute anterior circulation LVO in our cohort could improve the 90-day mRS score and the proportion of patients with scores of 0-1, increase the reperfusion rate after the first pass and enhance early neurological improvement, while decreasing the incidence of ICH and sICH.