Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke

Neurosurgery. 2015 Jun;76(6):680-6; discussion 686. doi: 10.1227/NEU.0000000000000694.


Background: The importance of underlying atherosclerotic intracranial artery stenosis (ICAS) in hyperacute stroke patients who receive endovascular therapy remains unknown.

Objective: To report and compare the outcomes of multimodal endovascular therapy in patients with hyperacute stroke with and without underlying ICAS.

Methods: A total of 172 consecutive patients with acute stroke were treated with multimodal endovascular therapy that was heavily weighted toward stent-based thrombectomy. Patients with ICAS underwent emergent intracranial angioplasty or stenting. Data were compared between patients with and without ICAS. Revascularization was defined as Thrombolysis in Cerebral Infarction grade ≥2b. A favorable outcome was defined as a modified Rankin Scale score ≤2 or equal to the premorbid modified Rankin Scale score at 3 months.

Results: ICAS was responsible for acute ischemic symptoms in 40 patients (22.9%). Revascularization and favorable outcome occurred more frequently in the ICAS group than in the control group (95% vs 81.8%, P = .04; 65% vs 40.2%, P = .01, respectively). The median baseline National Institutes of Health Stroke Scale score was significantly lower in the ICAS group compared with the control group (10 vs 12; P = .002). There were no significant differences between the 2 groups in the rates of symptomatic hemorrhage and mortality.

Conclusion: Emergent intracranial angioplasty with or without stenting is safe and feasible and yields a high rate of revascularization and favorable outcome in patients with hyperacute stroke and underlying ICAS. Patients with underlying ICAS have less severe infarctions at presentation and higher successful revascularization after multimodal endovascular therapy in the setting of hyperacute stroke compared with those with other stroke subtypes.

MeSH terms

  • Adult
  • Aged
  • Angioplasty / methods*
  • Brain / surgery
  • Combined Modality Therapy
  • Constriction, Pathologic / surgery
  • Female
  • Humans
  • Intracranial Arteriosclerosis / pathology*
  • Male
  • Middle Aged
  • Stents
  • Stroke / pathology*
  • Stroke / surgery*
  • Thrombectomy / methods
  • Thrombolytic Therapy
  • Treatment Outcome
  • United States