Korean J Radiol.  2019 May;20(5):739-748. 10.3348/kjr.2018.0809.

Current Opinion on Endovascular Therapy for Emergent Large Vessel Occlusion Due to Underlying Intracranial Atherosclerotic Stenosis

Affiliations
  • 1Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 2Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 3Department of Radiology, Chonnam National University Medical School, Gwangju, Korea. radyoon@jnu.ac.kr

Abstract

For recanalization of emergent large vessel occlusions (ELVOs), endovascular therapy (EVT) using newer devices, such as a stent retriever and large-bore catheter, has shown better patient outcomes compared with intravenous recombinant tissue plasminogen activator only. Intracranial atherosclerotic stenosis (ICAS) is a major cause of acute ischemic stroke, the incidence of which is rising worldwide. Thus, it is not rare to encounter underlying ICAS during EVT procedures, particularly in Asian countries. ELVO due to underlying ICAS is often related to EVT procedure failure or complications, which can lead to poor functional recovery. However, information regarding EVT for this type of stroke is lacking because large clinical trials have been largely based on Western populations. In this review, we discuss the unique pathologic basis of ELVO with underlying ICAS, which may complicate EVT procedures. Moreover, we review EVT data for patients with ELVO due to underlying ICAS and suggest an optimal endovascular recanalization strategy based on the existing literature. Finally, we present future perspectives on this subject.

Keyword

Atherosclerosis; Intracranial; Cerebral infarction; Endovascular; Thrombectomy; Glycoprotein-IIb/IIIa inhibitor; Percutaneous transluminal angioplasty; Stenting

MeSH Terms

Angioplasty
Asian Continental Ancestry Group
Atherosclerosis
Catheters
Cerebral Infarction
Constriction, Pathologic*
Humans
Incidence
Stents
Stroke
Thrombectomy
Tissue Plasminogen Activator
Tissue Plasminogen Activator
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