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Direct Stenting of Intracranial Atherosclerosis-related Acute Large Vessel Occlusion

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Abstract

Purpose

Endovascular reperfusion therapy (ERT) in patients with intracranial atherosclerosis (ICAS)-related acute large vessel occlusion (ALVO) may require different strategies based on the underlying culprit plaque lesion. This study investigated the effectiveness and safety of direct stent placement in ICAS-related ALVO compared with initially attempted mechanical thrombectomy (MT) with or without rescue treatment.

Methods

Direct stenting for ICAS-related ALVO was performed in 30 consecutive patients between January 1, 2012, and December 31, 2018. As a control for comparison, MT with or without rescue stenting for patients with ICAS-related ALVO was performed in 73 consecutive patients during the same period. Clinical outcomes were assessed by measuring modified Rankin Scale (mRS) at 90 days.

Results

Patients who underwent direct stenting and those who underwent MT with or without rescue stenting showed no significant differences in baseline characteristics. There was a higher proportion of patients with mRS 0–2 at 90 days in the direct stenting group than in the MT with or without rescue stenting group [24 (80.0%) vs. 34 (46.6%); p = 0.004]. Successful recanalization to modified thrombolysis in cerebral infarction category 2b or 3 was achieved in 93.3% of patients who underwent direct stenting, and in 90.4% of patients who underwent MT with or without rescue stenting.

Conclusion

Direct stenting is an effective and safe option for ICAS-related ALVO. Further studies are needed to confirm that endovascular treatments are effective and safe in patients with ALVO and underlying ICAS.

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Abbreviations

ALVO:

Acute large vessel occlusion

CI:

Confidence interval

CTA:

Computed tomography angiography

DWI:

Diffusion weighted imaging

ERT:

Endovascular reperfusion therapy

HARM:

Hyperintense acute reperfusion marker

ICAS:

Intracranial atherosclerosis

LSCW:

Last significant clinical worsening

LVO:

Large vessel occlusion

MRA:

Magnetic resonance angiography

MRI:

Magnetic resonance imaging

mRS:

Modified Rankin scale

mTICI:

Modified thrombolysis in cerebral infarction

MT:

Mechanical thrombectomy

NIHSS:

National Institutes of Health Stroke Scale

TIA:

Transient ischemic attack

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Funding

This work was supported by a research grant from Jeju National University Hospital in 2019.

Author information

Authors and Affiliations

  1. Department of Neurology, Jeju National University Hospital, Jeju, Korea (Republic of)

    Joong-Goo Kim & Jay Chol Choi

  2. Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Olympicro 43-gil 88, 05505, Seoul, Songpa-gu, Korea (Republic of)

    Joong-Goo Kim, Dae Chul Suh, Yunsun Song & Deok Hee Lee

Authors
  1. Joong-Goo Kim
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  2. Dae Chul Suh
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Contributions

DC Suh conceptualized and designed the study. DC Suh, YS Song and J.-G. Kim reviewed the articles and collected the data. DC Suh, YS Song, DH Lee and J.-G. Kim recruited patients. YS Song and J.-G. Kim analyzed the data. All authors contributed to data interpretation, writing, editing, and revisions of the final manuscript. All authors contributed to the production of the final version of this manuscript.

Corresponding author

Correspondence to Dae Chul Suh.

Ethics declarations

Conflict of interest

J.-G. Kim, D.C. Suh, Y. Song, J.C. Choi and D.H. Lee declare that they have no competing interests.

Ethical standards

Ethical approval was granted in accordance with national requirements, and the need for written informed consent was waived. (Institutional Review Board of Asan Medical Center).

Additional information

Availability of data and material

The data and material used in the present study are available from the corresponding author on request.

Caption Electronic Supplementary Material

62_2020_934_MOESM1_ESM.docx

Supplemental data 1. Flowchart of the patient selection process according to technique in patients with ICAS-related LVO.

Supplemental data 2. Baseline characteristics of patients who underwent direct stenting and mechanical thrombectomy with or without rescue stenting.

Supplemental data 3. Clinical and imaging outcomes in patients with ICAS-related ALVO who underwent direct stenting and mechanical thrombectomy with or without rescue stenting.

Supplemental data 4. Distribution of clinical outcome at three months according to the methods of endovascular reperfusion therapy for intracranial atherosclerosis-related acute large vessel occlusion.

Supplemental data 5. Comparison of clinical characteristics between performing the balloon angioplasty or not during endovascular reperfusion therapy.

Supplemental data 6. Comparison of clinical characteristics between performing the balloon angioplasty or not during endovascular reperfusion therapy.

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Kim, JG., Suh, D.C., Song, Y. et al. Direct Stenting of Intracranial Atherosclerosis-related Acute Large Vessel Occlusion. Clin Neuroradiol 31, 833–841 (2021). https://doi.org/10.1007/s00062-020-00934-x

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  • DOI: https://doi.org/10.1007/s00062-020-00934-x

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