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A comparison between different endovascular treatment strategies for acute large vessel occlusion due to intracranial artery atherosclerosis: data from ANGEL-ACT Registry

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

The aim of our study is to compare the characteristics and clinical outcomes among the different endovascular treatment (EVT) strategies for large vessel occlusion underlying intracranial atherosclerosis (ICAS-LVO) in a recent nationwide registry.

Methods

Patients with isolated ICAS-LVO were enrolled in our analysis and were categorized into three groups: first-line mechanical thrombectomy (MT) with rescue angioplasty and/or stenting (MT + RS), direct angioplasty and/or stenting without thrombectomy (DA), and MT alone. Baseline and periprocedural characteristics, successful recanalization, and 90-day functional outcomes were compared.

Results

Of 396 patients with isolated ICAS-LVO in our study, successful recanalization was achieved in 94.5%, 100%, and 90.9% of patients in the MT + RS, DA, and MT groups, respectively. The 90-day functional independence in the three groups was 50.8%, 59.0%, and 45.1%. The main efficacy and safety outcomes showed no significant differences among the groups. First-pass recanalization (FPR) was more observed in the MT group (43.4%), the recanalization rate per attempt in the MT group gradually decreased until the fourth attempt, and further maneuvers showed recanalization rates of ≈0% per attempt. MT + RS (adjusted odds ratio [aOR] 0.10, p < 0.0001) and DA (aOR 0.18, p = 0.0013) were associated with lower FPR rate than MT alone in the multivariable logistic regression.

Conclusions

The technical feasibility and favorable outcomes of several EVT strategies for ICAS-LVO were established in our study. First-line MT with a bailout angioplasty is a reasonable option for ICAS-LVO, and DA is an effective option for the cases when ICAS-LVO is strongly suspected before EVT procedure.

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Abbreviations

EVT:

Endovascular treatment

LVO:

Large vessel occlusion

ICAS:

Intracranial atherosclerosis

MT:

Mechanical thrombectomy

RS:

Rescue angioplasty and/or stenting

DA:

Direct angioplasty and/or stenting

FPR:

First-pass recanalization

OR/aOR:

Odds ratio/adjusted odds ratio

CI:

Confidence interval

AIS:

Acute ischemic stroke

SRT:

Stent-retriever thrombectomy

GPI:

Glycoprotein IIb/IIIa inhibitor

NIHSS:

National Institute of Health Stroke Scale

EDC:

Electronic data capture

mTICI:

Modified Thrombolysis in Cerebral Infarction

ICH:

Intracranial hemorrhage

mRS:

Modified Rankin Scale

sICH:

Symptomatic ICH

IQR:

Interquartile range

ORT:

Onset to recanalization time

PRT:

Puncture to recanalization time

AF:

Atrial fibrillation

IV:

Intravenous

DSA:

Digital subtraction angiography

TIA:

Transient ischemic attack

TTO:

Truncal-type occlusion

SVS:

Susceptibility vessel sign

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Acknowledgements

We thank all relevant clinicians, statistician, and imaging technicians.

Funding

This work was supported by the National Key Research and Development Program of China (Grant number 2016YFC1301501).

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China

    Jingyu Zhang, Baixue Jia, Zequan Yu, Yiming Deng, Dapeng Mo, Ning Ma, Feng Gao & Zhongrong Miao

  2. China National Clinical Research Center for Neurological Diseases, Beijing, China

    Yuesong Pan

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  1. Jingyu Zhang
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Contributions

ZM designed, led the study, and had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. JZ prepared the first draft of the report. YP analyzed the data. BJ and ZY were responsible for acquisition of data. YD, DM, NM, and FG were involved in revising the article for important intellectual content. All authors critically reviewed the article and approved the final version.

Corresponding author

Correspondence to Zhongrong Miao.

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Conflict of interest

The authors declare no competing interests.

Ethics approval and consent to participate

The protocol was approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University (approval ID: KY-2017–048-01). The appropriate permissions to access the patient database which provided the data for our study were granted by Beijing Tiantan Hospital.

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Zhang, J., Jia, B., Pan, Y. et al. A comparison between different endovascular treatment strategies for acute large vessel occlusion due to intracranial artery atherosclerosis: data from ANGEL-ACT Registry. Neuroradiology 64, 1627–1638 (2022). https://doi.org/10.1007/s00234-022-02933-w

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