Abstract WMP87: Characteristics and Outcome of Endovascular Treatment for Intracranial Atherosclerotic Occlusion: Comparison With Cardiogenic Cerebral Embolism in the K-NET Registry

Abstract

Purpose: The technique and efficacy of endovascular treatment (EVT) for intracranial atherosclerotic occlusion (ICAD) have not been established. The purpose of this study was to compare the outcomes of EVT for ICAD with those of cardiogenic cerebral embolism (CE) based on real-world data from a multicenter, prospective registry study (K-NET registry) involving 40 centers in Japan. Methods: The K-NET study enrolled 3187 EVTs in 2018-2021, of which 358 (11%) were ICAD and 1870 (59%) were CE. Medium vessel occlusion and tandem lesions were excluded. Indications and methods of treatment were performed at the discretion of each center. The primary endpoint was mRS: 0-2 at 90 days, and secondary endpoints included degree of recanalization, symptomatic intracranial hemorrhage. Results: The ICAD and CE groups showed significant differences in median age 73 and 78 years, 36% and 51% female, and baseline NIHSS 16 and 19, respectively. The occluded vessels were ICA 15% and 25%, MCA (M1/M2) 71% and 68%, and BA/VA 14% and 7%. Recanalization rates (TICI2b/3) were 75% and 91%. Time from puncture to recanalization was 68 and 42 minutes, and symptomatic intracranial hemorrhage was significantly different between 1.4% and 4.2%, while good outcome was similar between 40% and 38%. Balloon angioplasty was the treatment technique in 35% and 1.1%, and intracranial stents in 6.4% and 0.05%, respectively. Reocclusion was 3.1% and 0%, recurrent stroke 6.4% and 2.8%, and repeat endovascular treatment 5% and 0.6%, respectively. Factors significantly associated with good outcome in both groups were age, NIHSS, ASPECTS, recanalization, time from presentation to recanalization, and intracranial hemorrhage; in the ICAD group, additional significant factors were intravenous tPA and time from puncture to recanalization. Conclusion: EVT for ICAD was characterized by younger age, lower NIHSS, lower recanalization rate, longer puncture-recanalization time, but outcomes were similar to the CE group. The ICAD group had more additional procedures for recanalization, re-occlusion, and recurrence than the CE group.