BACKGROUND: Intracranial artery atherosclerotic stenosis (ICAS) is among the causes of intracranial large artery occlusion (LVO). The optimal treatment strategy for patients with ischemic stroke due to ICAS-related LVO remains unclear. In this retrospective case series, we discussed our experience with direct angioplasty as frontline therapy for ICAS-related LVO. METHODS: We extracted data for patients who had a known pre-existing ICAS and undergone direct angioplasty as frontline therapy for ICAS-related LVO in the anterior circulation at our institution between January 2019 and December 2019. We analysed procedural details, the degree of reperfusion, functional outcomes, and complications. Successful reperfusion was defined as a modified Treatment in Cerebral Ischemia (mTICI) score of 2 b - 3. Functional outcomes at 90 days were assessed using modified Rankin Scale (mRS) scores (good outcome: mRS of 0-2). RESULTS: We analysed data for five patients (mean age: 51.6 ± 11 years). The mean time from symptom onset to recanalization was 371 ± 38.6 min. Occlusions involved the first segment of the middle cerebral artery in four patients and the intracranial internal carotid artery in one patient. Successful reperfusion was achieved in four (80%) patients. The remaining patient (20%) underwent intracranial stenting as rescue therapy, achieving a final mTICI of 2a. No re-occlusion was observed on follow-up images. Four patients (80%) achieved good outcomes at 90 days. There were no cases of symptomatic intracranial hemorrhage, although asymptomatic intracranial haemorrhage was observed in one patient. CONCLUSION: Direct angioplasty may represent an alternative treatment strategy in patients with acute ischemic stroke due to known ICAS-related LVO.
BACKGROUND:Intracranial artery atherosclerotic stenosis (ICAS) is among the causes of intracranial large artery occlusion (LVO). The optimal treatment strategy for patients with ischemic stroke due to ICAS-related LVO remains unclear. In this retrospective case series, we discussed our experience with direct angioplasty as frontline therapy for ICAS-related LVO. METHODS: We extracted data for patients who had a known pre-existing ICAS and undergone direct angioplasty as frontline therapy for ICAS-related LVO in the anterior circulation at our institution between January 2019 and December 2019. We analysed procedural details, the degree of reperfusion, functional outcomes, and complications. Successful reperfusion was defined as a modified Treatment in Cerebral Ischemia (mTICI) score of 2 b - 3. Functional outcomes at 90 days were assessed using modified Rankin Scale (mRS) scores (good outcome: mRS of 0-2). RESULTS: We analysed data for five patients (mean age: 51.6 ± 11 years). The mean time from symptom onset to recanalization was 371 ± 38.6 min. Occlusions involved the first segment of the middle cerebral artery in four patients and the intracranial internal carotid artery in one patient. Successful reperfusion was achieved in four (80%) patients. The remaining patient (20%) underwent intracranial stenting as rescue therapy, achieving a final mTICI of 2a. No re-occlusion was observed on follow-up images. Four patients (80%) achieved good outcomes at 90 days. There were no cases of symptomatic intracranial hemorrhage, although asymptomatic intracranial haemorrhage was observed in one patient. CONCLUSION: Direct angioplasty may represent an alternative treatment strategy in patients with acute ischemic stroke due to known ICAS-related LVO.
Authors: Kilian M Treurniet; Albert J Yoo; Olvert A Berkhemer; Hester F Lingsma; Anna M M Boers; Puck S S Fransen; Debbie Beumer; Lucie A van den Berg; Marieke E S Sprengers; Sjoerd F M Jenniskens; Geert J Lycklama À Nijeholt; Marianne A A van Walderveen; Joseph C J Bot; Ludo F M Beenen; René van den Berg; Wim H van Zwam; Aad van der Lugt; Robert J van Oostenbrugge; Diederik W J Dippel; Yvo B W E M Roos; Henk A Marquering; Charles B L M Majoie Journal: Stroke Date: 2016-11-08 Impact factor: 7.914
Authors: Bruce C V Campbell; Peter J Mitchell; Timothy J Kleinig; Helen M Dewey; Leonid Churilov; Nawaf Yassi; Bernard Yan; Richard J Dowling; Mark W Parsons; Thomas J Oxley; Teddy Y Wu; Mark Brooks; Marion A Simpson; Ferdinand Miteff; Christopher R Levi; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Miriam Priglinger; Timothy Ang; Rebecca Scroop; P Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G Phan; Winston Chong; Ronil V Chandra; Christopher F Bladin; Monica Badve; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M Desmond; Geoffrey A Donnan; Stephen M Davis Journal: N Engl J Med Date: 2015-02-11 Impact factor: 91.245
Authors: Olvert A Berkhemer; Puck S S Fransen; Debbie Beumer; Lucie A van den Berg; Hester F Lingsma; Albert J Yoo; Wouter J Schonewille; Jan Albert Vos; Paul J Nederkoorn; Marieke J H Wermer; Marianne A A van Walderveen; Julie Staals; Jeannette Hofmeijer; Jacques A van Oostayen; Geert J Lycklama à Nijeholt; Jelis Boiten; Patrick A Brouwer; Bart J Emmer; Sebastiaan F de Bruijn; Lukas C van Dijk; L Jaap Kappelle; Rob H Lo; Ewoud J van Dijk; Joost de Vries; Paul L M de Kort; Willem Jan J van Rooij; Jan S P van den Berg; Boudewijn A A M van Hasselt; Leo A M Aerden; René J Dallinga; Marieke C Visser; Joseph C J Bot; Patrick C Vroomen; Omid Eshghi; Tobien H C M L Schreuder; Roel J J Heijboer; Koos Keizer; Alexander V Tielbeek; Heleen M den Hertog; Dick G Gerrits; Renske M van den Berg-Vos; Giorgos B Karas; Ewout W Steyerberg; H Zwenneke Flach; Henk A Marquering; Marieke E S Sprengers; Sjoerd F M Jenniskens; Ludo F M Beenen; René van den Berg; Peter J Koudstaal; Wim H van Zwam; Yvo B W E M Roos; Aad van der Lugt; Robert J van Oostenbrugge; Charles B L M Majoie; Diederik W J Dippel Journal: N Engl J Med Date: 2014-12-17 Impact factor: 91.245
Authors: Sami Al Kasab; Zayed Almadidy; Alejandro M Spiotta; Aquilla S Turk; M Imran Chaudry; John P Hungerford; Raymond D Turner Journal: J Neurointerv Surg Date: 2016-08-08 Impact factor: 5.836
Authors: Ramanan Ganeshan; Alexander H Nave; Jan F Scheitz; Katharina A Schindlbeck; Karl Georg Haeusler; Christian H Nolte; Kersten Villringer; Jochen B Fiebach Journal: J Neurointerv Surg Date: 2017-11-18 Impact factor: 5.836
Authors: G Marnat; F Delvoye; S Finitsis; B Lapergue; F Gariel; A Consoli; J-P Desilles; M Mazighi; C Dargazanli; R Bourcier; J Darcourt; V Chalumeau; M Elhorany; F Clarençon; S Richard; B Gory; I Sibon Journal: AJNR Am J Neuroradiol Date: 2021-06-11 Impact factor: 4.966