Stent Delivery Research Articles

Feasibility of rescue stenting technique in patients with acute ischemic stroke due to middle cerebral artery occlusion after failed thrombectomy: A single-center retrospective experience.

BackgroundDespite remarkable advancements in intra-arterial mechanical thrombectomy (IAT), recanalization failure rates up to 24% have been reported. Recently, permanent stent placement (rescue stent, RS) during IAT has been suggested as an optional modality for better reperfusion and outcomes in these patients. However, previous studies were limited owing to non-standardized procedure protocols and small sample sizes. Here, we aimed to determine the efficacy and safety of RS in patients with acute ischemic stroke (AIS) with middle cerebral artery (MCA) occlusion.MethodsOf the 243 patients in our IAT database (2015–2021), 183 were identified as having MCA occlusion alone. Among them, we extracted 53 patients in whom the IAT failed to show thrombolysis in cerebral ischemia (TICI) scores of 2A or worse. Intraoperatively, RS was deployed in 22 patients (RS group), whereas 31 patients (no-stent group) received IAT without stenting. The baseline characteristics and radiologic and clinical outcomes were reviewed. Comparisons between the groups and multivariate logistic analyses for recanalization and good functional outcomes (modified Rankin Scale 0–2) were performed.ResultsNo baseline differences were noted (RS vs. no-stent); however, the recanalization outcomes (59.1% vs. 25.8%, p = 0.15) and proportion of good modified Rankin Scale scores (45.5% vs. 19.4%, p = 0.041) were better in the RS group. The parameters of symptomatic ICH (9.7% vs. 9.4%) and mortality (6.5% vs. 5.7%) showed no significant difference. In the multivariate analyses, ‘hypertension’ and ‘RS deployment’ were identified as significantly associated factors with recanalization and good prognosis.ConclusionIn select patients with MCA occlusion AIS after failed IAT, the RS technique can be an optional rescue treatment modality for acquiring better functional outcomes and delayed recanalization.

Inflammation-triggered dual release of nitroxide radical and growth factor from heparin mimicking hydrogel-tissue composite as cardiovascular implants for anti-coagulation, endothelialization, anti-inflammation, and anti-calcification

Cardiovascular implants made from heterogeneous tissues (HT) often clinically face premature failures such as thrombosis, inflammation, and calcification. Herein, we report a hydrogel-tissue composite exhibiting inflammation instructive release of multiple components towards preventing coagulation, promoting endothelial growth, and modulating reactive oxygen species (ROS) homeostasis. The hydrogel composed of MMP-responsive segment-crosslinked heparin mimicking polymer was loaded with a nitroxide radical via ROS cleavable boronic ester bonds and vascular endothelial growth factor (VEGF) via electrostatic attraction. Matrix metalloproteinase (MMP), which reportedly showed elevated expression in inflammation response to foreign implant degraded the hydrogel and led to the release of heparin mimicking polymer and VEGF, enhancing its anti-coagulation capacity and accelerating the growth of endothelial cells on it. In addition, the composite could sense oxidation biosignal present in the inflammation environment and subsequently release a ROS scavenger for auto-regulation of ROS balance. Subcutaneous implantation in mice suggested that the composite could steer the immune response toward an anti-inflammation state and subcutaneous implantation in rats suggested an anti-calcification effect of it. The enhanced hemocompatibility and endothelialization effects in vivo were further confirmed by the endovascular implantation of tissues via membrane-covered stent delivery. The current findings demonstrate that the incorporation of functional hydrogel into the tissue sophistically exploiting host response for controlled release of multiple active cargos is a feasible approach to boost the anticoagulant, endothelialization, anti-inflammatory, and anti-calcification functions of HT-based cardiovascular implants.

Experience in using the combined method "Rendezvous" in interventions on the distal biliary tract

The article presents our own experience of observation during interventions on the distal biliary tract using a combined method – "Rendezvous" in patients with pathology of the pancreatobiliary zone, complicated by obstruction of the bile ducts. In one case, with a pronounced adhesive process of the abdominal cavity with a surgical aid, the endoscope was carried out to the descending branch of the duodenum. Towards the endoscope through the stump of the cystic duct, a conductor string was brought down, which made it possible to visualize the major duodenal papilla (MDP), to perform retrograde papillosphincterotomy with choledocholithotomy. In the second case, if it was impossible to pass the guidewire retrogradely beyond the area of the tumor narrowing, an alternative method was used – bringing it down by percutaneous transhepatic access towards the endoscope to install a retrograde stent delivery system.

Real-World Experience with a 60-mm-Long Stent in the Setting of Primary Percutaneous Coronary Intervention.

Primary percutaneous coronary intervention (PPCI) represents a timely procedure that requires speedy revascularization. Moreover, PPCI in diffuse coronary lesions remains to be challenging even in the hands of experienced operators as the use of a long stent may increase the difficulty of the procedure in terms of stent delivery, deployment, and optimization. However, the practicability and clinical outcomes of deployment of a 60-mm-long stent in the setting of PPCI remain to be determined. The study is a retrospective observational analysis in a prospective cohort. The prospectively gathered data of consecutive patients from June 2016 to December 2019, who underwent PPCI with BioMime sirolimus-eluting stents 2.5-3.0/60 mm or 3.0-3.5/60 mm were analyzed at 1 year regarding the primary outcome of major adverse cardiovascular and cerebrovascular events (MACCE) and target lesion revascularization (TLR). A total of 88 cases were included in the study; 23 cases underwent PPCI, whereas 65 underwent nonPPCI. The PPCI group had a mean age of 65.7 ± 10.9 years compared with 63.3 ± 9.6 years (P = 0.34) in the nonPPCI group. Eighty-three percentage of PPCI were males compared with 94% of their nonPPCI counterparts (P = 0.20). In addition, the prevalence of hypertension was more common in the PPCI group (87% vs. 63%, P = 0.03). There was no statistically significant difference between the two groups regarding other comorbidities. The most common culprit vessel was the left anterior descending artery (57%) in the PPCI group and the right coronary artery (58%) in the nonPPCI. The use of a stent with a diameter of 2.5-3.0 mm was more common in both groups (61% in PPCI vs. 66% in nonPPCI, P = 0.8). MACCE occurred in four patients during a year of follow-up. One occurred in the PPCI group (4%) compared with three in the nonPPCI group (5%) (P = 1.00). TLR was required in two cases, one in each group (4% vs. 2%, P = 0.46). The use of a 60-mm-long stent in the setting of PPCI has an excellent 12-month outcome in procedural success, MACCE, and TLR. Large randomized studies are required to confirm these results.

Stent Delivery Shaft Fracture Case Report: A Fractured Relationship

Percutaneous coronary intervention has been a major interventional medical development of our times, being a life-saving procedure in the setting of acute coronary syndrome, and providing significant improvements in quality of life for patients with chronic coronary syndromes. Complications of coronary intervention have continued to downtrend, facilitated by improvements in stent and wire technology, the aggressive use of antiplatelets, and the regular use of invasive anatomical and physiological assessments. The authors present the case of a challenging and rare procedural complication, that of stent delivery shaft fracture requiring emergency snare extraction.

Hybrid repair of a giant left subclavian artery aneurysm and arch coarctation in a patient with Larsen syndrome.

A 34-year-old male was admitted to our emergency department with progressively aggravated hoarseness and sudden onset of chest and neck pain. General examination was remarkable for severe scoliosis (Panel A) and a blood pressure gradient of >20 mmHg between upper and lower extremities. Computed tomography angiography (CTA) revealed a giant left subclavian artery (LSA) aneurysm (55 × 47 mm, asterisk), aortic arch coarctation, and severely tortuous descending aorta. In addition, an isolated left vertebral artery (ILVA) arose from the arch (Panel B-C). Whole-exome sequencing analysis identified p.Gly488Ser mutation in FLNB, indicating a diagnosis of Larsen syndrome. Considering the patient’s refusal of open surgery and the acutely worsening symptoms due to the pending rupture of the LSA aneurysm, a less-invasive hybrid approach was accepted as reasonable by interdisciplinary consensus. First, through the right femoral artery, a 20 F sheath (W.L. Gore and Associates, Newark, Del) was advanced across the arch coarctation, facilitating the delivery of the aortic stent. Then, a Gore cTAG stent was implanted at the arch distal to the innominate artery orifice, followed by a balloon-expandable Cheatham-Platinum stent (NuMED, Hopkinton, USA) deploying at the coarctation segment. Second, the membrane of the cTAG stent was penetrated with an aspiration biopsy needle through the left common carotid artery (LCCA). The fenestration was then expanded by balloons and LCCA was stented with a 120 × 40 mm covered endograft (Panel D–F; Supplementary material online, Video S1). After the endovascular procedures, the ILVA was anastomosed end-to-side to LCCA. Finally, the distal outlet of LSA aneurysm was ligated, and a bypass from LCCA to distal LSA was performed with a 6 mm Gore-Tex prosthetic graft (Panel G). Completion angiography (Panel H; Supplementary material online, Video S2) and postoperative CTA (Panel I) confirmed exclusion of the aneurysm and patency of all the supra-arch vessels. The postoperative course was uneventful and the patient was discharged on the 4th day after surgery.

A Prospective, Multicenter, Single-Group Target-Value Clinical Trial to Evaluate the Safety and Efficacy of a Large Bore Aspiration Catheter System for the Endovascular Treatment of Acute Ischemic Stroke.

ObjectiveThis study was conducted to determine the safety and efficacy of the Esperance® Distal Access Catheter (0.071”), a novel large bore aspiration catheter in treating acute ischemic stroke (AIS) with large vessel occlusion (LVO).MethodsA prospective multicenter clinical trial involving 15 stroke centers was performed. Baseline characteristics, procedural data, and angiographic and clinical outcomes of all acute stroke procedures (from May 2020 to March 2021) using the novel large bore aspiration catheter were analyzed.ResultsDuring the study period, 160 consecutive patients were recruited. The mean age and median baseline NIHSS were 65.4 years and 16, respectively. Successful reperfusion was achieved in 147 (91.9%) cases [at least modified Thrombolysis in Cerebral Infarction (mTICI) 2b] with aspiration alone, with complete reperfusion (mTICI 3) in 94 (58.8%) cases. Successful/complete first pass reperfusion was achieved in 104 (64.60%) cases, including mTICI 2b in 34 (21.1%) cases and mTICI 3 in 70 (43.5%) cases. The time from groin puncture to successful reperfusion was 44 (33, 62) min. There were 16 (9.9%) cases requiring rescue therapy using stent-retriever. Procedure-related complications included 2 (1.3%) cases of arterial perforation, 2 (1.3%) cases of arterial dissection, 12 (7.5%) cases of distal embolization, and 1(0.6%) case of puncture site infection. The rate of symptomatic intracranial hemorrhage (sICH) was 3.8% and mortality rate was 13.8%. A total of 99 (62.3%) cases had a favorable outcome (mRS 0–2) at 90 days.ConclusionsIn current practice, the first-line aspiration approach with the Esperance® Distal Access Catheter is safe and efficacious. This device may achieve high reperfusion rates with lower instances of rescue stent retriever therapy.

Efficacy of shockwave C2 coronary intravascular lithotripsy for management of severely calcified left anterior descending stenosis

Severely calcified coronary lesions remain a formidable hurdle for percutaneous coronary intervention as it averts the stent delivery and complete stent apposition. To overcome this Achilles heel of an interventional cardiology, a current US FDA approved method named shockwave intravascular lithotripsy (S-IVL; Shockwave Medical, Inc) is used for its treatment. Herein, we report a case of a 53-year-old dyslipidemic male with severely calcified left anterior descending artery (LAD) lesion that was successfully treated with S-IVL and drug-eluting stent implantation. At first, the patient was presented with complaints of chest pain and breathlessness. His coronary angiogram revealed heavily calcified stenosis in diffuse mid LAD—completely totally occluded mid-diagonal (D) 1 that was checked through retrograde filling via collateral and calcified stenosis in ostial D2, mild stenosis in ostial left circumflex and mild stenosis at distal before crux 50% stenosis in dominant right coronary artery. Following this, it was decided to proceed with primary percutaneous coronary intervention with S-IVL to LAD. After successful delivery of S-IVL to LAD, a Tetriflex sirolimus eluting stent (Sahajanand Medical Technologies Ltd., Surat, India) was successfully implanted at LAD. Finally, the patient’s condition was stabilized and discharged after two days of index procedure.

P83 PERCUTANEOUS INTERVENTION FOR AORTIC COARCTATION IN YOUNG ADULTS: A CASE SERIES

Abstract Introduction Aortic coarctation is one of the most frequent misdiagnosed congenital heart diseases and the most commonly missed foetal congenital heart disease. In adulthood the treatment of this pathology is primarily percutaneous. Case Presentation We present a case series of two young patients. The formers was a 37–years–old male with recent onset of heart failure symptoms due to misdiagnosed congenital aortic coarctation. The latter was a 39–years–old woman with exertional dyspnoea and a previous operated bicuspid aortic valve; in this case the intervention for the aortic defect was made in a second time, in order to avoid a huge demolishing surgical procedure. The execution of a diagnostic multimodality imaging allowed to detect the aortic coarctation, which received indication to percutaneous correction of the aortic defect after the multidisciplinary “Heart Team” discussion (image 2 and 3). In the cath–lab, the use of novel digital techniques, integrating the angiographic images with previously acquired angio–CT, allowed a safe stent delivery with minimum amount of contrast injection (image 1). Conclusion Percutaneous treatment of aortic coarctation in young adult is safe and effective. Fusion imaging tools could be very useful to optimize procedural results and sparing contrast dye, suggesting their possible implementation in different percutaneous procedures.

Stent delivery during primary angioplasty: speed doesn�t matter

Stent delivery during primary angioplasty: speed doesn�t matter

Deflation speed of the stent delivery system and primary angioplasty results: a randomized study

Deflation speed of the stent delivery system and primary angioplasty results: a randomized study

TCTAP C-105 Nightmare in Cathlab- When Simple Case Turns to Complex by Tearing Off the Stent Delivery System Shaft

TCTAP C-105 Nightmare in Cathlab- When Simple Case Turns to Complex by Tearing Off the Stent Delivery System Shaft

Stent-based delivery of AAV2 vectors encoding oxidation-resistant apoA1

In-stent restenosis (ISR) complicates revascularization in the coronary and peripheral arteries. Apolipoprotein A1 (apoA1), the principal protein component of HDL possesses inherent anti-atherosclerotic and anti-restenotic properties. These beneficial traits are lost when wild type apoA1(WT) is subjected to oxidative modifications. We investigated whether local delivery of adeno-associated viral (AAV) vectors expressing oxidation-resistant apoA1(4WF) preserves apoA1 functionality. The efflux of 3H-cholesterol from macrophages to the media conditioned by endogenously produced apoA1(4WF) was 2.1-fold higher than for apoA1(WT) conditioned media in the presence of hypochlorous acid emulating conditions of oxidative stress. The proliferation of apoA1(WT)- and apoA1(4FW)-transduced rat aortic smooth muscle cells (SMC) was inhibited by 66% ± 10% and 65% ± 11%, respectively, in comparison with non-transduced SMC (p < 0.001). Conversely, the proliferation of apoA1(4FW)-transduced, but not apoA1(WT)-transduced rat blood outgrowth endothelial cells (BOEC) was increased 41% ± 5% (p < 0.001). Both apoA1 transduction conditions similarly inhibited basal and TNFα-induced reactive oxygen species in rat aortic endothelial cells (RAEC) and resulted in the reduced rat monocyte attachment to the TNFα-activated endothelium. AAV2-eGFP vectors immobilized reversibly on stainless steel mesh surfaces through the protein G/anti-AAV2 antibody coupling, efficiently transduced cells in culture modeling stent-based delivery. In vivo studies in normal pigs, deploying AAV2 gene delivery stents (GDS) preloaded with AAV2-eGFP in the coronary arteries demonstrated transduction of the stented arteries. However, implantation of GDS formulated with AAV2-apoA1(4WF) failed to prevent in-stent restenosis in the atherosclerotic vasculature of hypercholesterolemic diabetic pigs. It is concluded that stent delivery of AAV2-4WF while feasible, is not effective for mitigation of restenosis in the presence of severe atherosclerotic disease.

Emergency rescue stent grafting for a ruptured degenerated graft that bypassed coarctation of the aorta: a case report

A 33-year-old man who had undergone bypass from the distal aortic arch to the proximal descending thoracic aorta with a Dacron graft to treat coarctation of the aorta 20 years prior presented to the emergency department with massive hemoptysis. He was diagnosed with a graft-to-bronchial fistula. After thoracic endovascular aneurysm repair through the coarctation, aortic replacement was performed 3 weeks later. Therefore, emergency-rescue thoracic endovascular aneurysm repair can be considered for preventing aortic rupture.

Safety and Efficacy of Cangrelor in Acute Stroke Treated with Mechanical Thrombectomy: Endovascular Treatment of Ischemic Stroke Registry and Meta-analysis.

Rescue therapies are increasingly used in the setting of endovascular therapy for large-vessel occlusion strokes. Among these, cangrelor, a new P2Y12 inhibitor, offers promising pharmacologic properties to join the reperfusion strategies in acute stroke. We assessed the safety and efficacy profiles of cangrelor combined with endovascular therapy in patients with large-vessel-occlusion stroke. We performed a retrospective patient data analysis in the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France from July 2018 to December 2020 and conducted a systematic review and meta-analysis using several data bases. Indications for cangrelor administration were rescue strategy in case of refractory intracranial occlusion with or without intracranial rescue stent placement, and cervical carotid artery stent placement in case of cervical occlusion (tandem occlusion or isolated cervical carotid occlusion). In the clinical registry, 44 patients were included (median initial NIHSS score, 12; prior intravenous thrombolysis, 29.5%). Intracranial stent placement was performed in 54.5% (n = 24/44), and cervical stent placement, in 27.3% (n = 12/44). Adjunctive aspirin and heparin were administered in 75% (n = 33/44) and 40.9% (n = 18/44), respectively. Rates of symptomatic intracerebral hemorrhage, parenchymal hematoma, and 90-day mortality were 9.5% (n = 4/42), 9.5% (n = 4/42), and 24.4% (n = 10/41). Favorable outcome (90-day mRS, 0-2) was reached in 51.2% (n = 21/41), and successful reperfusion, in 90.9% (n = 40/44). The literature search identified 6 studies involving a total of 171 subjects. In the meta-analysis, including our series data, symptomatic intracerebral hemorrhage occurred in 8.6% of patients (95% CI, 5.0%-14.3%) and favorable outcome was reached in 47.6% of patients (95% CI, 27.4%-68.7%). The 90-day mortality rate was 22.6% (95% CI, 13.6%-35.2%). Day 1 artery patency was observed in 89.7% (95% CI, 81.4%-94.6%). Cangrelor offers promising safety and efficacy profiles, especially considering the complex endovascular reperfusion procedures in which it is usually applied. Further large prospective data are required to confirm these findings.

Thrombosis or vasospasm: The utility of intraoperative neuromonitoring during TCAR.

Transcarotid artery revascularization (TCAR) has become more prevalent as a treatment modality for carotid stenosis. Many centers perform TCAR without any adjunctive neuromonitoring, for example, somatosensory-evoked potential (SSEP) and electroencephalogram (EEG). We present a case of transcarotid artery revascularization (TCAR) performed with concomitant somatosensory-evoked potential (SSEP) and electroencephalogram (EEG) neuromonitoring in the setting of concerning intraoperative angiographic images. TCAR was undertaken for a 58year-old man presenting with symptomatic left carotid stenosis and right ICA occlusion. Based on his comorbidities, pre-existing conditions, and the need for dual antiplatelet therapy, TCAR was offered as an alternative to standard carotid endarterectomy. Intraoperatively, following stent delivery, no flow was appreciated through the carotid stent or distal ICA. Neuromonitoring remained stable and was reassuring for distal ICA spasm with no-reflow phenomenon. The patient tolerated the procedure well and has had no stent-related complications through 10months of follow-up. This case highlights the utility of neuromonitoring with TCAR as an adjunct to intraoperative decision-making in the setting of suspected internal carotid artery (ICA) vasospasm versus thrombosis after stent delivery.

Rescue stenting for acute ischemic stroke with refractory emergent large vessel occlusion in the modern thrombectomy era

Background and purposeRescue stenting is used as a bailout technique during mechanical thrombectomy for stroke. We performed a retrospective study analyzing outcomes of patients that received a stent as a bailout measure and compared results to a control group. MethodsWe identified all patients who underwent a mechanical thrombectomy for a large vessel occlusion between January 2010 and October 2019. Subjects with mTICI 0–2 A after at least three passes were defined as failed MT and constituted the control group (NSG-controls). Patients that received a rescue stent (RSG) formed the study group. ResultsComparative analysis of patient demographics between NSG-controls and SRG was performed. Baseline characteristics and comorbidities were not significantly different between both groups. NIHSS at admission and IV t-PA were not significantly different among both groups (16.5 vs. 14.2, p = 0.19) and (39.4% vs. 29.4%, p = 0.30), respectively. There was no significant difference in procedural and post-procedural complications between both the groups. In the RSG, 24 patients (82.4%) achieved favorable revascularization outcomes. NIHSS at discharge (p = 0.01) was higher in the NSG-controls, while favorable functional outcome at three months (12% vs. 39.2%, p = 0.01) was observed at a higher proportion in the RSG. There was also a significant mortality difference, with 15.2% mortality in the RSG compared to 35.1% mortality in the NSG-controls (p = 0.03). In multivariate analysis, stenting was an independent predictor of favorable outcome (OR: 10.0, p = 0.009). ConclusionHerein, we demonstrated that rescue stenting is a feasible, safe, and effective procedure to improve stroke outcomes and should be seriously considered if the primary mechanical thrombectomy is not successful.

A Novel Method for Urinary Tract Reconstruction in Transplanted Embryonic Kidneys Using the Hybrid Stent: A Pig Study.

A Novel Method for Urinary Tract Reconstruction in Transplanted Embryonic Kidneys Using the Hybrid Stent: A Pig Study.

Intravascular lithotripsy during percutaneous coronary intervention for calcified coronary lesions: analysis of patient and procedural characteristics and clinical outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Coronary artery calcification is frequently encountered during percutaneous coronary intervention (PCI). It can reduce PCI success and increase intra-procedural and post-procedural complications, including stent embolization, under-expansion and mal-apposition. Intravascular lithotripsy (IVL) is a new tool developed to treat calcified coronary lesions. Purpose Retrospective analysis of all cases of intravascular lithotripsy performed within our local health district to examine patient and procedural characteristics and clinical outcomes. Methods All patients undergoing PCI with intravascular lithotripsy between September 2019-August 2021 within our local health district were analysed. Patient and procedural characteristics and clinical outcomes were recorded. Results 67 patients (50 men) were included with mean age 71.4 ± 8.7years. Risk factors prevalence included smoking (34%), hypertension (82%), dyslipidaemia (69%) and diabetes (46%). Trans-radial artery access was used in 38 patients (57%). IVL was performed most commonly in the left anterior descending artery (52%),[Figure 1]. IVL was utilised in 9 chronic total occlusions and 12 bifurcation lesions. Intracoronary (IC) imaging was performed in 59 patients (88%), intravascular ultrasound in 41(61%) and optical coherence tomography in 18 (27%). 41 (69%) patients had imaging performed pre and post IVL and post PCI. IC imaging identified 14 cases with 270º calcification arc and 45 cases with 360º arc. Nine cases (13.4%) required rotational atherectomy prior to IVL (most commonly 1.75mm burr). Mean reference vessel diameter was 3.2 ± 0.3mm. Mean lesion length was 36.3 ± 16.5mm. Mean pre-PCI stenosis was 85.5 ± 10.8%. Drug eluting stents were successfully deployed in 57 cases (85%), 10 had balloon angioplasty alone. Mean stent length was 39.2 ± 17.8mm. Mean post-PCI stenosis was 4.5 ± 13.3% (median 0%). Figure 2 shows a statistically significant increase in minimum lumen diameter and minimum lumen area post-IVL and minimal-stent-area (MSA) post-PCI. Mean stent expansion was 83%. Mean screening time 35.8 ± 17.8 minutes with mean contrast used 207.3 ± 78.7mL. No sustained arrhythmias or side-branch loss occurred. Vessel rupture was recorded in one patient necessitating urgent cardiac surgery (due to oversized balloon) and in 4 cases the IVL balloon could not cross the lesion. Conclusion Our experience shows that IVL is safe and effective and facilitates stent delivery and expansion. Intracoronary imaging is important to determine the need for calcium modification and evaluate its success prior to stent delivery and to confirm optimised stent expansion. Abstract Figure. Breakdown of PCI Artery Abstract Figure. IC Dimensions Pre/Post IVL/Post PCI

Abstract TMP68: Underlying Intracranial Atherosclerosis Disease Is Associated With Worse Outcome In Acute Large Vessel Occlusion Undergoing Endovascular Therapy

Introduction: Acute large vessel occlusion (LVO) can be secondary to thromboembolism or underlying intracranial atherosclerotic disease (ICAD). Data on the management of LVO due to underlying ICAD are scarce. Hypothesis: We hypothesized that patients with ICAD would have worse clinical outcomes following mechanical thrombectomy (MT) than those without ICAD. Methods: We performed a retrospective analysis of consecutive patients who underwent MT for LVO in a large academic comprehensive stroke center between 01/2018 and 05/2021. Presence of underlying ICAD at the site of LVO was determined by the treating interventionalist. We compared outcomes including in-hospital mortality and 90-day modified Rankin Scale (mRS) between those with and without underlying ICAD, adjusting for relevant covariates using logistic regression. Results: Among 195 patients (mean age 67.4+15.1 years, 56.9% female, 81% black, median NIHSS score 15), underlying ICAD was present in 39 (20.0%). Stent-retrievers were used 196 patients with only 3 having rescue stent placement. There were no significant differences in baseline factors amongst the two groups except diabetes was more common (69.2% vs. 49.7%, p=0.028) and intravenous thrombolysis provided less often (17.9% vs. 36.5%, p=0.027) in those with ICAD. TICI 2B or higher was achieved in 82.1% of ICAD compared with 94.3% of non-ICAD patients (p=0.012). Mortality was more common (50.0% vs. 30.8%, p=0.025) and good functional outcome (mRS 0-2) at 90 days was less common (10.8% vs. 30.0%, p=0.002) in the ICAD group. Adjusting for age, diabetes, intravenous thrombolysis, baseline NIHSS score, and final TICI score, underlying ICAD was an independent predictor of mRS 0-2 at 90 days (OR 4.5, 95% CI 1.4-14.2, p=0.010). Conclusion: Underlying ICAD is associated with 4.5-fold increase in poor functional outcome in patients with LVO undergoing traditional MT. Further research is needed to understand factors associated with poor outcomes investigate alternative interventional approaches and medical management in this high-risk population.