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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.

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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

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