Abstract TP10: Endovascular Treatment for Acute Ischemic Stroke With Intracranial Atherosclerotic Occlusive Disease

Abstract

Background: Treatment strategy for acute ischemic stroke with intracranial atherosclerotic disease remains unknown. The aims are to evaluate whether revascularization rates, procedural complications, functional outcomes in patients with emergent endovascular treatment for intracranial atherosclerotic occlusive disease. Methods: A retrospective review of emergent endovascular treatment from 2003 to 2016 was carried out for acute ischemic stroke patients who had intracranial atherosclerotic occlusion or severe stenosis. Patients were underwent endovascular treatment which included intra-arterial thrombolysis, balloon angioplasty and stenting. Intracranial atherosclerotic disease was defined as significant focal stenosis at the occlusion site, which was evident on final angiographic assessment or observed during endovascular treatment. Results: A total of 58 consecutive patients were identified. Forty-five were male (78%) and the mean age was 68 years. Atherosclerotic arteries were 24 in middle cerebral artery, 8 in internal carotid artery, 22 in basilar artery, and 4 in vertebral artery. Successful recanalization (TICI 2b and 3) was observed in 45 patients (78%). Intra-arterial thrombolysis, balloon angioplasty without stenting, and balloon angioplasty with stenting by coronary stents were performed in 31 patients (53%), in 45 patients (78%), and in 19 patients (33%), respectively. Acute in-stent thrombosis was observed in 4 patients. Stent retriever and Penumbra system were used in 5 patients and 9 patients, respectively. The postprocedural hemorrhagic complication was observed in 5 patients (8.6%). The incidence of good outcome (90-day modified Rankin scale ≤2) were 68% in anterior circulation and 38% in posterior circulation. Conclusion: Our data suggest that emergent endovascular treatment for patients with intracranial atherosclerotic occlusive disease is safe and feasible. Particularly, balloon angioplasty with or without stenting have a high rate of recanalization and favorable outcome.