Abstract
Background and Purpose
Data on the management of large vessel occlusion in patients with anterior circulation acute ischemic stroke (AIS) due to underlying intracranial stenosis are scarce. The aim of this retrospective study was to compare endovascular treatment and outcome in AIS patients with and without underlying stenosis of the M1 segment.
Materials and Methods
A total of 533 acute stroke patients with an isolated M1 occlusion who underwent mechanical thrombectomy between 02/2010 and 08/2017 were included. Underlying intracranial atherosclerotic stenosis (ICAS) was present in 10 patients (1.9%), whereas 523 patients (98.1%) had an embolic occlusion without stenosis.
Results
There was no difference in age, admission National Institutes of Health Stroke Scale, risk factors, Alberta stroke program early CT score or collaterals between the groups. Procedure time (155 vs 40 min, P = 0.001) was significantly longer in the ICAS group where rescue stent-angioplasty was performed in all patients. There was no statistical difference in final modified thrombolysis in cerebral infarction score between both groups (70 vs 88%, P = 0.115). Favorable outcome (modified Rankin Scale ≤ 2) at 90 days was less frequent in patients with ICAS than in the embolic group (0 vs 49.4%, P = 0.004). The mortality rate tended to be higher in the ICAS group (44.4 vs 19.4%, P = 0.082).
Conclusion
In patients with AIS, rescue therapy with stent placement to treat underlying ICAS of the M1 segment is technically feasible; however, in our study, a significantly lower rate of favorable outcome was observed in these patients compared to those with thromboembolic M1 occlusions.
Level of Evidence
Level 3, non-randomized controlled study.
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Unrelated: Dr Gralla reports acting as a global principal investigator of the STAR study; a clinical events committee member of the PROMISE study (Penumbra); and the principal investigator for the SWIFT DIRECT study (Medtronic). Dr Gralla also reports serving as a consultant for Medtronic and receiving Swiss National Science Foundation grants for magnetic resonance imaging in stroke. Professor Fischer is a global PI for the SWIFT DIRECT study (Medtronic) and receives research grants from SNSF. Professor Arnold has received speaker honoraria from Bayer, Boehringer Ingelheim, and Covidien, and scientific advisory board honoraria from Bayer, Boehringer Ingelheim, BMS, Pfizer, Covidien, Daichy Sankyo, and Nestlé Health Science. Dr Mosimann receives research grants from SNSF to study new therapeutic options for cerebral aneurysms. Mr Kaesmacher receives research grants from the Swiss Stroke Society and the Bangerter Foundation. All other authors have nothing to disclose.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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This study has obtained IRB approval from (indicate the relevant board), and the need for informed consent was waived. The registry was approved by the local ethics committee (Kantonale Ethikkommission für die Forschung Bern, Bern, Switzerland, Amendment Access Number: 231/2014).
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Dobrocky, T., Kaesmacher, J., Bellwald, S. et al. 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 42, 863–872 (2019). https://doi.org/10.1007/s00270-019-02187-9
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DOI: https://doi.org/10.1007/s00270-019-02187-9