J Stroke.
2018 Sep;20(3):394-403. 10.5853/jos.2018.01627.
Prognosis of Acute Intracranial Atherosclerosis-Related Occlusion after Endovascular Treatment
- Affiliations
-
- 1Department of Neurology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea.
- 2Department of Neurology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. sungil.sohn@gmail.com
- 3Department of Neurosurgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
- 4Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea. yangha.hwang@gmail.com
- 5Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
- 6Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
- 7Department of Radiology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea.
- 8Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
- 9Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- KMID: 2428774
- DOI: http://doi.org/10.5853/jos.2018.01627
Abstract
- BACKGROUND AND PURPOSE
Little is known about prognosis after endovascular therapy (EVT) for acute large artery occlusion (LAO) caused by underlying intracranial atherosclerotic stenosis (ICAS). Therefore, we investigated the prognosis following EVT according to the underlying etiology of LAO.
METHODS
Patients from the Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention-Korean Retrospective (ASIAN KR) registry (n=720) were included if their occlusion was in the intracranial anterior circulation and their onset-to-puncture time was < 24 hours. Occlusion was classified according to etiology as follows: no significant stenosis after recanalization (Embolic group), and fixed significant focal stenosis in the occlusion site with flow impairment or re-occlusion observed during EVT (ICAS group). Patients were excluded when significant extracranial carotid lesions existed, and when the intracranial occlusion was intractable to EVT so that the etiology was undetermined. The effect of angiographic etiologic classification on outcomes was evaluated using multivariable analysis that was adjusted for potential confounders.
RESULTS
Among eligible patients (n=520), 421 and 99 were classified in the Embolic and ICAS groups, respectively. Patients in the Embolic and ICAS groups had similar successful reperfusion rates with EVT (79.6% vs. 76.8%, P=0.537) and 3-month functional independence (54.5% vs. 45.5%, P=0.104). In multivariable analysis, ICAS-related occlusion (odds ratio, 0.495; 95% confidence interval, 0.269 to 0.913; P=0.024) showed poorer 3-month functional independence compared to embolic occlusion.
CONCLUSIONS
After EVT, patients with acute ICAS-related occlusion have relatively poor functional outcomes compared to those with embolic occlusion. Novel strategies need to be developed to improve EVT outcomes for ICAS occlusion.
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