Endovascular recanalization for intracranial atherosclerotic disease-related acute large artery occlusion in anterior circulation

Objective To evaluate the effect of endovascular recanalization on acute ischemic stroke with large artery occlusion (LAO) in anterior circulation due to intracranial atherosclerotic disease (ICAD). Methods We conducted a retrospective analysis about 49 cases of ICAD-related LAO undergoing endovascular treatment at Department of Neurointervention, People＇s Hospital of Henan Province from June 2014 to June 2016. Recanalization result was assessed by catheter angiography according to Thrombolysis in Cerebral Ischemia (TICI) scale and the neurological function 1 week post procedure was evaluated by NIHSS (National Institutes of Health Stroke Scale). The 90-day outcome was assessed based on the modified Rankin Scale (mRS). In-stent restenosis was evaluated by DSA at 6-month follow-up. Results Among the 49 cases ICAD-related LAO enrolled into this study, the mean time from puncture to recanalization was (78.4±29.0) minutes. The rate of successful intraoperative recanalization (TICI score of 2b-3)was 87.8% (43/49). Intraoperative embolization occurred in 5 patients. Among them, 1 patient underwent stent retrieval and 3 received intra-arterial tirofiban treatment resulting in recanalization in 2 cases. The CT scan at 24 h post surgery demonstrated intracerebral hemorrhage in 7 cases including 3 symptomatic cases. The mean NIHSS score (8.8±4.1) 1 week post procedure was significantly lower than that prior to operation (15.6±3.9). At 3-month follow-up, 6 deaths were reported. The mean mRS score was (2.9±1.7) and the rate of good outcome was 57.1% (28/49). DSA was conducted in 15 patients at 6 months post stent placement which reported 2 cases(13.3%) of intrastent restenosis. Conclusion Endovascular treatment seems beneficial for patients with ICAD-related LAO to achieve good recanalization and clinical outcome. Key words: Stroke; Atherosclerosis; Treatment outcome; Mechanical thrombectomy