Skip to main content

Advertisement

SpringerLink
Log in

Differences in Safety and Efficacy of Endovascular Treatment for Acute Ischemic Stroke

A Propensity Score Analysis of Intracranial Atherosclerosis-Related Occlusion versus Embolism

  • Original Article
  • Published:
Clinical Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

The prognosis after endovascular treatment (EVT) of acute arterial occlusions due to intracranial atherosclerotic disease (ICAD) may differ from those due to embolism. The aim was to evaluate whether safety and efficacy of EVT differ among patients with middle cerebral artery (MCA) M1 occlusion from ICAD or embolism.

Methods

A database review was conducted to identify EVT patients with acute MCA M1 occlusion from November 2013 to December 2018.The patients were divided into the ICAD group and embolic group according to the etiology of occlusion. Using propensity score analysis, patients with ICAD-related occlusion and embolism underwent 1:1 matching. Angiographic results, complications, and clinical outcomes were compared.

Results

A total of 217 patients (ICAD: 51; embolism: 166) were identified. After propensity score matching, 45 patients with ICAD-related occlusion and 45 with embolism were matched. All baseline covariates except atrial fibrillation were statistically indistinguishable. The rate of successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] 2b–3) was similar between the two groups, while the rate of mTICI 3 in the ICAD group was higher. No statistical difference was observed in the rate of postprocedural intracranial hemorrhage. The rate of favorable outcome (modified Rankin Scale [mRS] ≤2) and mortality at 90 days was comparable.

Conclusion

This propensity score analysis demonstrated that the EVT patients with acute ICAD-related MCA M1 occlusion had similar angiographic and clinical outcomes compared to those with M1 embolism on a similar baseline condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

AIS:

Acute ischemic stroke

ASPECT:

Alberta Stroke Program Early Computed Tomography

CT:

Computed tomography

CTA:

Computed tomography angiography

DSA:

Digital subtraction angiography

EVT:

Endovascular treatment

ICAD:

Intracranial atherosclerotic disease

ICH:

Intracranial hemorrhage

MCA:

Middle cerebral artery

mRS:

Modified Rankin scale

mTICI:

Modified thrombolysis in cerebral infarction

NIHSS:

National Institutes of Health Stroke Scale

References

  1. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Majoie CB, Dippel DW; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20.

    Article  Google Scholar 

  2. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A; REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372:2296–306.

    Article  CAS  Google Scholar 

  3. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–30.

    Article  CAS  Google Scholar 

  4. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM; EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372:1009–18.

    Article  CAS  Google Scholar 

  5. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R; SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t‑PA vs. t‑PA alone in stroke. N Engl J Med. 2015;372:2285–95.

    Article  CAS  Google Scholar 

  6. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millán M, Davis SM, Roy D, Thornton J, Román LS, Ribó M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG; HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723–31.

    Article  Google Scholar 

  7. Suri MF, Qiao Y, Ma X, Guallar E, Zhou J, Zhang Y, Liu L, Chu H, Qureshi AI, Alonso A, Folsom AR, Wasserman BA. Prevalence of intracranial atherosclerotic stenosis using high-resolution magnetic resonance angiography in the general population: the atherosclerosis risk in communities study. Stroke. 2016;47:1187–93.

    Article  Google Scholar 

  8. Horie N, Tateishi Y, Morikawa M, Morofuji Y, Hayashi K, Izumo T, Tsujino A, Nagata I, Matsuo T. Acute stroke with major intracranial vessel occlusion: characteristics of cardioembolism and atherosclerosis-related in situ stenosis/occlusion. J Clin Neurosci. 2016;32:24–9.

    Article  Google Scholar 

  9. Kim GE, Yoon W, Kim SK, Kim BC, Heo TW, Baek BH, Lee YY, Yim NY. Incidence and clinical significance of acute reocclusion after emergent angioplasty or stenting for underlying intracranial stenosis in patients with acute stroke. AJNR Am J Neuroradiol. 2016;37:1690–5.

    Article  CAS  Google Scholar 

  10. Al Kasab S, Almadidy Z, Spiotta AM, Turk AS, Chaudry MI, Hungerford JP, Turner RD 4th. Endovascular treatment for ais with underlying ICAD. J Neurointerv Surg. 2017;9:948–51.

    Article  Google Scholar 

  11. Jia B, Feng L, Liebeskind DS, Huo X, Gao F, Ma N, Mo D, Liao X, Wang C, Zhao X, Pan Y, Li H, Liu L, Wang Y, Wang Y, Miao ZR; EAST Study Group. Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis. J Neurointerv Surg. 2018;10:746–50.

    Article  Google Scholar 

  12. Lee JS, Hong JM, Lee KS, Suh HI, Demchuk AM, Hwang YH, Kim BM, Kim JS. Endovascular therapy of cerebral arterial occlusions: intracranial atherosclerosis versus embolism. J Stroke Cerebrovasc Dis. 2015;24:2074–80.

    Article  Google Scholar 

  13. Lee JS, Lee SJ, Yoo JS, Hong JH, Kim CH, Kim YW, Kang DH, Kim YS, Hong JM, Choi JW, Ovbiagele B, Demchuk AM, Sohn SI, Hwang YH. Prognosis of acute intracranial atherosclerosis-related occlusion after endovascular treatment. J Stroke. 2018;20:394–403.

    Article  Google Scholar 

  14. Dobrocky T, Kaesmacher J, Bellwald S, Piechowiak E, Mosimann PJ, Zibold F, Jung S, Arnold M, Fischer U, Gralla J, Mordasini P. Stent-retriever thrombectomy and rescue treatment of M1 occlusions due to underlying intracranial atherosclerotic stenosis: cohort analysis and review of the literature. Cardiovasc Intervent Radiol. 2019;42:863–72.

    Article  Google Scholar 

  15. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19:604–7.

    Article  Google Scholar 

  16. Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS study group. Alberta stroke programme early ct score. Lancet. 2000;355:1670–4.

    Article  CAS  Google Scholar 

  17. Zaidat OO, Castonguay AC, Gupta R, Sun CJ, Martin C, Holloway WE, Mueller-Kronast N, English JD, Linfante I, Dabus G, Malisch TW, Marden FA, Bozorgchami H, Xavier A, Rai AT, Froehler MT, Badruddin A, Nguyen TN, Taqi MA, Abraham MG, Janardhan V, Shaltoni H, Novakovic R, Yoo AJ, Abou-Chebl A, Chen PR, Britz GW, Kaushal R, Nanda A, Issa MA, Nogueira RG. North american Solitaire stent retriever acute stroke registry: post-marketing revascularization and clinical outcome results. J Neurointervent Surg. 2014;6:584–8.

    Article  Google Scholar 

  18. Hacke W1, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Höxter G, Mahagne MH, Hennerici M.Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA. 1995;274:1017–25.

    Article  CAS  Google Scholar 

  19. Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, Johnston KC, Johnston SC, Khalessi AA, Kidwell CS, Meschia JF, Ovbiagele B, Yavagal DR; American Heart Association Stroke Council. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. Stroke. 2015;46:3020–35.

    Article  CAS  Google Scholar 

  20. Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, Clark W, Budzik R, Zaidat OO; SWIFT Trialists. Solitaire flow restoration device versus the merci retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 2012;380:1241–9.

    Article  Google Scholar 

  21. Nogueira RG1, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, Liebeskind DS, Smith WS; TREVO 2 Trialists. Trevo versus merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012;380:1231–40.

    Article  Google Scholar 

  22. Kang DH, Kim YW, Hwang YH, Park SP, Kim YS, Baik SK. Instant reocclusion following mechanical thrombectomy of in situ thromboocclusion and the role of low-dose intra-arterial tirofiban. Cerebrovasc Dis. 2014;37:350–5.

    Article  CAS  Google Scholar 

  23. Yoon W, Kim SK, Park MS, Kim BC, Kang HK. Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke. Neurosurgery. 2015;76:680–6.

    Article  Google Scholar 

  24. Li H, Zhang Y, Zhang L, Li Z, Xing P, Zhang Y, Hong B, Yang P, Liu J. Endovascular treatment of acute ischemic stroke due to intracranial atherosclerotic large vessel occlusion: a systematic review. Clin Neuroradiol. 2019; https://doi.org/10.1007/s00062-019-00839-4.

    Article  PubMed  Google Scholar 

  25. Kang DH, Yoon W. Current opinion on endovascular therapy for emergent large vessel occlusion due to underlying intracranial atherosclerotic stenosis. Korean J Radiol. 2019;20:739–48.

    Article  Google Scholar 

  26. Kim SJ, Seok JM, Bang OY, Kim GM, Kim KH, Jeon P, Chung CS, Lee KH, Alger JR, Liebeskind DS. MR mismatch profiles in patients with intracranial atherosclerotic stroke: a comprehensive approach comparing stroke subtypes. J Cereb Blood Flow Metab. 2009;29:1138–45.

    Article  Google Scholar 

  27. Liebeskind DS, Cotsonis GA, Saver JL, Lynn MJ, Turan TN, Cloft HJ, Chimowitz MI; Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Investigators. Collaterals dramatically alter stroke risk in intracranial atherosclerosis. Ann Neurol. 2011;69:963–74.

    Article  Google Scholar 

  28. Forbrig R, Lockau H, Flottmann F, Boeckh-Behrens T, Kabbasch C, Patzig M, Mpotsaris A, Fiehler J, Liebig T, Thomalla G, Onur OA, Wunderlich S, Kreiser K, Herzberg M, Wollenweber FA, Prothmann S, Dorn F. Intracranial rescue stent angioplasty after stent-retriever thrombectomy: multicenter experience. Clin Neuroradiol. 2019;29:445–57.

    Article  Google Scholar 

Download references

Funding

The authors state that this work has received funding from Shanghai health system excellent talents training program (No. 2017YQ034), Shanghai pujiang talent program (No. 16PJD003) and Shanghai pudong new area special disease construction project (No. PWZ2b2017-09).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China

    Wenjin Yang, Yongxin Zhang, Zifu Li, Lei Zhang, He Li, Weilong Hua, Hongjian Zhang, Mingtao Feng, Hongjian Shen, Pengfei Xing, Yongwei Zhang, Pengfei Yang & Jianmin Liu

  2. Department of Health Statistics, Second Military Medical University, 800 Xiangyin Road, 200433, Shanghai, China

    Qi Chen

  3. Department of Neurosurgery, Pudong New area people’s Hospital, 490 xinjian south road, 200299, Shanghai, China

    Wenjin Yang

Authors
  1. Wenjin Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yongxin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zifu Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. He Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Weilong Hua
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hongjian Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mingtao Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hongjian Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Pengfei Xing
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Qi Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yongwei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Pengfei Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Jianmin Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Pengfei Yang or Jianmin Liu.

Ethics declarations

Conflict of interest

W. Yang, Y. Zhang, Z. Li, L. Zhang, H. Li, W. Hua, H. Zhang, M. Feng, H. Shen, P. Xing, Q. Chen, Y. Zhang, P. Yang and J. Liu declare that we have no financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Additional information

Wenjin Yang and Yongxin Zhang contributed equally to this work.

Caption Electronic Supplementary Material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, W., Zhang, Y., Li, Z. et al. Differences in Safety and Efficacy of Endovascular Treatment for Acute Ischemic Stroke. Clin Neuroradiol 31, 457–464 (2021). https://doi.org/10.1007/s00062-020-00899-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00062-020-00899-x

Keywords

Search

Navigation