Direct angioplasty for acute ischemic stroke due to intracranial atherosclerotic stenosis-related large vessel occlusion

Abstract

Background Intracranial artery atherosclerotic stenosis (ICAS) is among the causes of intracranial large artery occlusion (LVO). The optimal treatment strategy for patients with ischemic stroke due to ICAS-related LVO remains unclear. In this retrospective case series, we discussed our experience with direct angioplasty as frontline therapy for ICAS-related LVO. Methods We extracted data for patients who had a known pre-existing ICAS and undergone direct angioplasty as frontline therapy for ICAS-related LVO in the anterior circulation at our institution between January 2019 and December 2019. We analysed procedural details, the degree of reperfusion, functional outcomes, and complications. Successful reperfusion was defined as a modified Treatment in Cerebral Ischemia (mTICI) score of 2 b − 3. Functional outcomes at 90 days were assessed using modified Rankin Scale (mRS) scores (good outcome: mRS of 0–2). Results We analysed data for five patients (mean age: 51.6 ± 11 years). The mean time from symptom onset to recanalization was 371 ± 38.6 min. Occlusions involved the first segment of the middle cerebral artery in four patients and the intracranial internal carotid artery in one patient. Successful reperfusion was achieved in four (80%) patients. The remaining patient (20%) underwent intracranial stenting as rescue therapy, achieving a final mTICI of 2a. No re-occlusion was observed on follow-up images. Four patients (80%) achieved good outcomes at 90 days. There were no cases of symptomatic intracranial hemorrhage, although asymptomatic intracranial haemorrhage was observed in one patient. Conclusion Direct angioplasty may represent an alternative treatment strategy in patients with acute ischemic stroke due to known ICAS-related LVO.

A Multicenter Preliminary Study of Cangrelor following Thrombectomy Failure for Refractory Proximal Intracranial Occlusions

“…[4][5][6] In this setting, aggressive management, including acute antiplatelet therapy and intracranial angioplasty or stent placement, has been reported. [8][9][10]19,[22][23][24][25] These pharmacologic and mechanical approaches are most often combined with promising results, considering the specific largevessel occlusion stroke subtype. To date, the optimal pharmacologic adjunctive therapy for this recently described rescue approach for refractory intracranial occlusion is yet to be determined.…”

Understanding of pathophysiology and optimal treatment for anterior circulation large vessel occlusion beyond 24 h from onset of stroke

“…[7] The use of a retrieval stent as the first approach to LVO with underlying atherosclerosis has been discussed previously. [8][9][10] In case 2, the patient received PTA for residual stenosis after thrombectomy. Since the crab crow sign [11] was found at the occlusion site, thrombectomy was initially performed.…”

Effect of Risk-Focused Diversified Safety Management Mode in Patients with Major Artery Stent Implantation

“…e primary cause of ischemic cerebrovascular disease and transient ischemic attack (TIA) in China is intracranial atherosclerotic stenosis (ICAS) [1,2]. e results of the 2014 CICAS study showed that 46.6% of patients with ischemic stroke and TIA in China had atherosclerosis and that patients with combined ICAS had severe symptoms and a high recurrence rate during the follow-up period [3,4].…”