Endovascular Treatment Of Large Vessel Occlusion: Intracranial Atherosclerosis Versus Cardioembolism

Back and Objectives:With the development of endovascular devices over the past decade,endovascular therapies have been found to improve recanalization rate and functional outcomes compared to Intravenous thrombolysis alone.However,large artery occlusion due to different etiology may react differently to the endovascular treatment.The aim of this study was to evaluate the safety and efficiency of endovascular therapy in the treatment of acute ischemic stroke within 8 hours from onset,and to explore the influencing factors to the endovascular therapy and the optimal management of LAO due to different etiology.Materias and methodsPatients with large artery occlusion of anterior corcullation received endovascular treatment within 8 hours from stroke onset were reviewed retrospectively during January 2014 to June 206.Clinical details were recorded,recanalization results were assessed by follow-up angiography immediately according to the Thrombolysis in Cerebral Infarction(TICI)scores,outcome at one week、three months were assessed by National Institutes of Health Stroke Scale(NIHSS)and modified Rankin Scale(mRS).Complications related to the procedure were recorded.Group differences were analyzed of ischemic stroke subtype of intracranial atherosclerotic disease(IAD)and cardioembolism(CE)on the efficacy of endovascular treatment in patients with acute large artery occlusion.Results102 patients received endovascular treatment were categorized to CE group(n=38)and underlying IAD group(n=45)according to the mTOAST,stroke of other determined etiology and undetermined etiology in 19 patients,Prevalence of male,tobacco,and CHD in IAD group were significantly higher than CE group.The baseline NIHSS score was lower in the IAD group.The prevalence of male(P= 0.007),tobacco(P=0.009),hypertension(P=0.015),diabete(P=0.045),and CHD(P=0.023)in IAD group were significantly higher than CE group,the initial rate of recanalization was low with stent retriever as first method in the IAD group(P<0.001),a majority of patients suffered angioplasty with or without stenting,and the final rate of recanalization was comparable,the procedure time was significantly longer in the IAD group than in the CE group(P=0.027).The clinical outcome,complications,and the mortality were comparable between two groups.ConclusionsClinical risk factors and treatment strategy of acute arterial occlusions due to IAD may differ from those due to CE.Emergent intracranial angioplasty with or without stenting is an efficient supplementary treatment in the patients with IAD.