Endovascular recanalization of symptomatic non–acute intracranial artery occlusion: Procedural and mid-term clinical outcomes in the anterior circulation

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Symptomatic non–acute intracranial arterial occlusion (NAICO) is not uncommon. We report a single-center experience of the feasibility and safety of endovascular treatment of anterior circulation NAICO and summarize the outcomes of patient groups with successful or failed recanalization. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Patients who underwent endovascular therapy for intracranial arterial stenosis between January 2010 and May 2017 were retrospectively reviewed. Thirty-eight patients with symptomatic NAICO (symptom onset &gt; 24 hours) in the anterior circulation were identified. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Successful recanalization was achieved in 76.3% of patients (29/38). Intraprocedural events occurred in 10.5% (4/38), including intima dissection ( n = 1), parent artery rupture ( n = 1) and acute in-stent thrombosis ( n = 2). Mean follow-up duration after successful recanalization was 36.5 months. One patient died 68 days after the procedure because of a newly developed posterior circulation stroke. Acute reocclusion was observed in two patients (6.7%); subacute or delayed reocclusion was observed in three patients (10%). Good final outcome (modified Rankin Scale score ≤ 2) was achieved in 25 of 28 patients (89.3%) at three months. Mean follow-up duration of the nine patients with failed recanalization was 41.4 months. Three patients underwent extra–intracranial bypass for worsening symptoms. The other six patients showed stable or improved neurological status with antiplatelet medications. Good final outcome was achieved in eight of nine patients (88.9%) at three months. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Endovascular revascularization can be a viable option with an acceptable safety profile in selected patients with symptomatic NAICO in the anterior circulation. Further characterization of aborted cases would facilitate proper patient selection for endovascular treatment. </jats:p></jats:sec>

Clinical Study of Symptomatic Nonacute Intracranial Large Arterial Occlusion with Endovascular Recanalization

“…[7][8][9][10][11][12] However, there was heterogeneity of outcomes and perioperative complications for endovascular recanalization, 13 and it was believed that there were differences in the difficulty and risk at different locations of occlusion. 2,14 The high perioperative complication rate and high postoperative restenosis/re-occlusion rate 15 greatly limit its wide application.…”

Safety and efficacy of endovascular recanalization for symptomatic non-acute atherosclerotic intracranial large artery occlusion

“…It could help to evaluate whether the occlusion is acute or subacute thrombosis or chronic plaque formation and evaluate the length and contortion of vessels. In addition, when the DSA shows a tapered end, the micro-guidewire tends to pass through the occlusion more easily (7).…”

Effects of endovascular recanalization on symptomatic non-acute occlusion of intracranial arteries

“…Atherosclerotic steno-occlusive disease of large intracranial arteries is a common cause of stroke across the world which is associated with a high risk of recurrent stroke and poor outcomes 1 – 3 . Non-acute symptomatic atherosclerotic occlusion of large intracranial arteries beyond 24 h from onset is common with a high rate of recurrent stroke of approximately 7.27% per year in China because of hemodynamic compromise and poor collateral circulation and constitutes a treatment dilemma 2 , 4 .…”