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From the Departments of Biomedical Systems Informatics (S.K., Jaewoong Kim, C.H., D.Y.) and Neurology (Joonho Kim, J.Y.), Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea; Department of Radiology, Central Draft Physical Examination Office of Military Manpower Administration, Daegu, Republic of Korea (D.K.); Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science (H.J.S. Y.K., S.J.), and Center for Digital Health (H.J.S., D.Y.), Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea; Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (S.H.L.); Departments of Radiology (M.H.) and Neurology (S.J.L.), Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea; and Institute for Innovation in Digital Healthcare, Severance Hospital, Seoul, Republic of Korea (D.Y.).

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Background Symptomatic acute occlusions of the internal carotid artery (ICA) below the circle of Willis can cause a variety of stroke symptoms, even if the major intracranial cerebral arteries remain patent; however, outcome and safety data are limited. Purpose To compare treatment effects and procedural safety of endovascular treatment (EVT) and best medical treatment (BMT) in patients with symptomatic acute occlusions of the ICA below the circle of Willis. Materials and Methods This retrospective, multicenter cohort study from 22 comprehensive stroke centers in Europe and Asia includes patients treated between January 1, 2008, and December 31, 2022.

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