Association Between Occlusion Type and Etiology of Acute Intracranial Large Artery Occlusion

Abstract

Objective: To investigate the diagnostic efficiency of truncal-type occlusion and branching-site occlusion in determining the etiology of intracranial large artery occlusion related acute ischemic stroke (AIS). Methods: Patients with intracranial large artery occlusion related AIS who received stent retriever (SR) thrombectomy from November 2014 to June 2019 were included in the study. All patients underwent angiography before SR thrombectomy, which was used to evaluate the occlusion type. Differences in the distribution of occlusion types in intracranial atherosclerosis (ICAS) and embolism were assessed, and the diagnostic indicators, including the area under the ROC curve (AUC), sensitivity, and specificity were calculated. Results: Of the 115 AIS patients with intracranial large artery occlusion, 42 were classified as having ICAS, and 73 having an embolism. In the ICAS group, branching-site occlusion was responsible for 3 (7%) cases and truncal-type occlusion for 39 (93%) cases, while in the embolism group, branching-site occlusion was responsible for 66 (90%) cases and truncal-type occlusion for 7 (10%) cases; the difference was statistically significant (all P < 0.01). The AUC for ICAS predicted by truncal-type occlusion was 0.916, with a sensitivity of 92.86%, and specificity of 90.41%. Conclusion: Truncal-type occlusion showed a high predictability of ICAS. Determine the etiology of intracranial large artery occlusion related AIS before SR thrombectomy may be most helpful in setting up optimal endovascular treatment strategies.

Keywords: intracranial atherosclerosis; intracranial large artery occlusion; stent; stroke; thrombectomy.

Figure 1

Revascularization for patients with ICAS. (A) The angiogram showed occlusion in the right middle cerebral artery M1. (B) The microcatheter reached the occlusion segment showing bifurcation of the middle cerebral artery, confirming the truncal-type occlusion. (C) Vessel revascularization after SR thrombectomy and residual stenosis. (D) The angiography showed that occlusion occurred again 10 min after surgery. (E) Rescue therapy with stenting was given for revascularization.

Figure 2

Revascularization for patients with embolism. (A) The angiogram showed the occlusion in the left middle cerebral artery. (B) The microcatheter reached the occlusion segment, and bifurcation was not observed at the distal end of the occlusion segment, which further confirmed the presence of branching-site occlusion. (C) Vessel revascularization after SR thrombectomy and no residual stenosis was observed.