Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Apr 2:10:308.
doi: 10.3389/fneur.2019.00308. eCollection 2019.

Endovascular Treatment of Acute Stroke Due to Intracranial Atherosclerotic Stenosis-Related Large Vessel Occlusion

Hyungjong Park  1   2 , Jang-Hyun Baek  3 , Byung Moon Kim  1
Affiliations
Review

Endovascular Treatment of Acute Stroke Due to Intracranial Atherosclerotic Stenosis-Related Large Vessel Occlusion

Hyungjong Park et al. Front Neurol. .

Abstract

Endovascular treatment (EVT) has become a standard treatment for acute ischemic stroke due to large vessel occlusion (LVO) in the anterior circulation. However, whether EVT tools used for intracranial atherosclerotic stenosis (ICAS)-related LVO are as safe and effective as for use in embolic LVO remains unclear. There have been only a few studies about EVT for ICAS-related LVO, and these studies revealed that mechanical thrombectomy with a stent retriever or contact aspiration was less effective and more time consuming in ICAS-related LVO than in embolic LVO. Because fast and successful recanalization (defined as modified Thrombolysis in Cerebral Ischemia grade, 2b or 3) is the most critical factor influencing favorable outcomes, it is important to determine the appropriate EVT strategy for fast recanalization of ICAS-related LVO. In this report, we review the results of mechanical thrombectomy using stent retriever or contact aspiration and rescue treatments after failure of mechanical thrombectomy for ICAS-related LVO. Finally, we propose the EVT strategy appropriate for ICAS-related LVO based on a literature review and our experience.

Keywords: acute stroke; endovascular treatment; intracranial atherosclerosis; large vessel occlusion; stenosis and cerebrovascular occlusion.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A schematic drawing of reocclusion mechanism after stent retriever or contact aspiration thrombectomy for intracranial atherosclerotic stenosis-related large vessel occlusion.
Figure 2
Figure 2
A schematic drawing of rescue treatment for reocclusion after initial recanalization of intracranial atherosclerotic stenosis-related large vessel occlusion.
Figure 3
Figure 3
Comparison of modified Rankin scale score among mechanical thrombectomy success, rescue stenting, and non-stenting groups. MT, mechanical thrombectomy.
Figure 4
Figure 4
The stepwise endovascular strategy appropriate for intracranial atherosclerotic stenosis-related large vessel occlusion. ICAS, intracranial atherosclerotic stenosis; LVO, large vessel occlusion; GRE-MR, gradient echo magnetic resonance imaging; HAS, hyperdense artery sign; NECT, non-enhanced computed tomography; TTO, truncal type occlusion; CT, computed tomography; SR, stent retriever; GPI, glycoprotein IIb/IIIa inhibitor.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. . Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. (2018) 49:e46–110. 10.1161/STR.0000000000000158 - DOI - PubMed
    1. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischemic stroke: a meta-analysis of individual patient data from five randomized trials. Lancet. (2016) 387:1723–31. 10.1016/S0140-6736(16)00163-X - DOI - PubMed
    1. Lapergue B, Blanc R, Gory B, Labreuche J, Duhamel A, Marnat G, et al. . Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER randomized clinical trial. JAMA. (2017) 318:443–52. 10.1001/jama.2017.9644 - DOI - PMC - PubMed
    1. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. . Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. (2018) 378:11–21. 10.1056/NEJMoa1706442 - DOI - PubMed
    1. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. (2018) 22:708–18. 10.1056/NEJMoa1713973 - DOI - PMC - PubMed

LinkOut - more resources