Underlying intracranial atherosclerotic disease is associated with worse outcomes in acute large vessel occlusion undergoing endovascular thrombectomy

J Stroke Cerebrovasc Dis. 2023 Aug;32(8):107227. doi: 10.1016/j.jstrokecerebrovasdis.2023.107227. Epub 2023 Jul 10.


Background: Data on large vessel occlusion (LVO) management due to intracranial atherosclerotic disease (ICAD) are scarce.

Objective: To compare clinical outcomes between patients with ICAD and those without ICAD following mechanical thrombectomy (MT).

Methods: We performed a retrospective analysis of consecutive patients who underwent MT for LVO in a large academic comprehensive stroke center, and compared in-hospital mortality, 90-day mortality, favorable functional outcome at 90 days, and symptomatic intracranial hemorrhage (ICH) using chi-squared tests and multivariate logistic regression analyses. We defined ICAD as observable plaque at occlusion site post-thrombectomy.

Results: Among 215 patients (mean age 67.1 ± 16.0 years; 60.5% female; 83.6% Black, median NIHSS score 16), ICAD was present in 38 patients (17.7%). Diabetes and dyslipidemia were more common in those with ICAD (57.9% vs. 38.4%, p = 0.027 and 29.0% vs. 14.7%, p = 0.035, respectively). Substantial reperfusion (TICI ≥2b) was achieved less often (84.2% vs. 94.4%, p = 0.031) but symptomatic ICH was also less common in ICAD patients (0% vs. 9.0%, p = 0.081). In-hospital and 90-day mortality were more common (36.8% vs. 15.8%, p = 0.003 and 52.6% vs. 26.6%, p = 0.002, respectively) and favorable functional outcome (mRS 0-2) at 90 days was less common (7.9% vs. 33.9%, p = 0.001) in ICAD patients. After adjusting for prognostic variables, ICAD was independently associated with in-hospital mortality (OR=4.1, 95% CI 1.7-9.7), 90-day mortality (OR=3.7, 95% CI 1.6-8.6), and poor functional outcome at 90 days (OR=5.5, 95% CI 1.6-19.4).

Conclusion: Symptomatic ICAD in a predominantly African American cohort is associated with increased odds of mortality and poor functional outcome at 90 days in patients with LVO undergoing MT.

Keywords: Intracranial atherosclerotic disease; Large vessel occlusion; Mechanical thrombectomy; Stroke.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia*
  • Female
  • Humans
  • Intracranial Arteriosclerosis* / complications
  • Intracranial Arteriosclerosis* / diagnostic imaging
  • Intracranial Arteriosclerosis* / therapy
  • Intracranial Hemorrhages / diagnostic imaging
  • Intracranial Hemorrhages / etiology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stroke*
  • Thrombectomy / adverse effects
  • Treatment Outcome