Angiographical Identification of Intracranial, Atherosclerosis-Related, Large Vessel Occlusion in Endovascular Treatment

Abstract

Identification of intracranial, atherosclerosis-related, large vessel occlusion (ICAS-LVO) is important to set up an optimal endovascular treatment strategy, as most ICAS-LVOs require specific endovascular modalities for efficient recanalization. However, there is currently no decisive way to identify ICAS-LVO for endovascular treatment. Instead of the few, non-specific, clinical and imaging findings that operators have depended on, this review focused on the occlusion type, one of angiographical methods to identify the ICAS-LVO. Occlusion type was originally devised for predicting procedural details and endovascular outcomes of ICAS-LVO. Among occlusion types, truncal-type occlusion is regarded as a surrogate marker for ICAS-LVO. Although rare, false positives or negatives in truncal-type occlusion are possible. Nonetheless, occlusion type was easy to apply and reliably predictive of procedural outcomes. Furthermore, occlusion type can be determined prior to the procedure, which could allow it to be more helpful in setting up an optimal strategy before starting endovascular treatment.

Effects of first pass recanalization on outcomes of contact aspiration thrombectomy

“…Given that the luminal diameter of the aspiration device could affect contact area and aspiration capacity, older generation of aspiration device could be another potential limitation of this study. Finally, since this study was conducted in an East Asian country where ICAS is responsible for approximately 17.6–30.3% of ELVO,16–20 the results might be affected by racial differences from previous studies conducted in the USA36–38. Nonetheless, in line with previous studies, the results of this study suggest that FPR might be a practical surrogate marker for evaluating the performance and clinical efficacy of emerging thrombectomy devices with various designs and technique, such as the combination of CAT and SRT.…”

“…The low FPR rate in the present study seemed to have resulted from a different study population (East Asia vs USA), older generation of aspiration device, and lower proportion of BGC use. In East Asia, the prevalence of intracranial atherosclerotic stenosis (ICAS) in acute stroke patients is 46.6% and, furthermore, ICAS is responsible for approximately 17.6–30.3% of ELVO 16–21. In a study comparing the efficacy of SRT and CAT in 146 cases of ICAS-related LVO, the rate of switching to an alternative thrombectomy technique (SRT to CAT or vice versa) after the frontline modality failed was significantly higher in the CAT group (40%) than in the SRT group (4.7%, p<0.001),22 which also might lower the FPR rate.…”

Immediate effects of first-line thrombectomy devices for intracranial atherosclerosis-related occlusion: stent retriever versus contact aspiration

“…However, which device is suitable for first-line therapy in ICAS-LVO is unclear, because most of the previous randomized trials were based on Western populations. Knowledge about which device is more effective in ICAS-LVO would be useful in selecting a more suitable device for patients with ICAS-LVO before EVT [ 13 – 15 ]. Recently, a study comparing outcome of SR and CA in ICAS-LVO patients at two hospitals was published [ 16 ].…”

Improving the Clinical Outcome in Stroke Patients Receiving Thrombolytic or Endovascular Treatment in Korea: from the SECRET Study

“…Although age, vascular risk factors other than dyslipidemia, and occlusion site did not change over time, stroke severity slightly decreased. This may be ascribed to the increase in reperfusion therapy for minor stroke and decrease in the prevalence of atrial fibrillation-or atrial flutter-related stroke [20,21]. Furthermore, time from stroke onset to ED was longer than those in previous studies because patient eligibility for EVT might be based more on imaging parameters recently, instead of the time window paradigm [22].…”