Adjunctive rescue therapy in acute large vessel occlusion secondary to underlying intracranial atherosclerotic disease

J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107907. doi: 10.1016/j.jstrokecerebrovasdis.2024.107907. Epub 2024 Aug 6.

Abstract

Background: The optimal treatment for patients with acute large vessel occlusion (LVO) secondary to intracranial atherosclerotic disease (ICAD) is unclear. Adjunctive rescue therapy with balloon angioplasty or stenting may be necessary to ensure vessel patency. We aimed to compare the safety and clinical outcomes of adjunctive rescue therapy vs lone thrombectomy for ICAD-related-LVO.

Methods: A retrospective propensity score matching analysis was performed in acute stroke patients who had endovascular thrombectomy between 2008 and 2021. We included patients with acute ICAD-related-LVO. The location of ICAD and exposure to thrombolysis were used to generate propensity score matching to estimate the likelihood of treatment by adjunctive rescue therapy. The primary clinical outcome (90-day modified rankin scale 0-2) and safety outcomes (symptomatic intracerebral hemorrhage) were assessed between the two groups.

Results: One-hundred and forty-four patients were included. The median (IQR) age was 68(59-76) and 52(36 %) were females. The baseline NIHSS was 12.5(8-19). Sixty-seven (47 %) patients had ICAD in M1 or M2 segments. Forty-six patients (67 %) had lone thrombectomy and twenty-one (28 %) had adjunctive rescue therapy. Propensity score matching did not demonstrate significant differences in 90-day modified Rankin Score 0-2 between lone thrombectomy (38.8 %) and adjunctive rescue therapy (39.3 %) (p = 0.3). Lone thrombectomy, compared to adjunctive rescue therapy, did not result in significantly more symptomatic intracerebral hemorrhages (2.8 % vs 8.3 %, p = 0.6), nor progressive occlusion (17 % vs 19 %, p = 0.8).

Conclusion: We did not find significant differences in clinical outcomes and safety between lone thrombectomy and adjunctive rescue therapy. Randomized controlled studies are required to resolve the equipoise in treatment of ICAD-related-LVO.

Keywords: Acute ischaemic stroke; Endovascular thrombectomy; Intracranial atherosclerotic disease; Intracranial stenting; Large vessel occlusion.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Angioplasty, Balloon* / adverse effects
  • Angioplasty, Balloon* / instrumentation
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / etiology
  • Cerebral Hemorrhage / surgery
  • Cerebral Hemorrhage / therapy
  • Combined Modality Therapy
  • Disability Evaluation
  • Endovascular Procedures / adverse effects
  • Female
  • Humans
  • Intracranial Arteriosclerosis* / complications
  • Intracranial Arteriosclerosis* / diagnostic imaging
  • Intracranial Arteriosclerosis* / physiopathology
  • Intracranial Arteriosclerosis* / therapy
  • Ischemic Stroke / diagnosis
  • Ischemic Stroke / diagnostic imaging
  • Ischemic Stroke / etiology
  • Ischemic Stroke / physiopathology
  • Ischemic Stroke / therapy
  • Male
  • Middle Aged
  • Recovery of Function
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Stents*
  • Thrombectomy* / adverse effects
  • Thrombolytic Therapy / adverse effects
  • Time Factors
  • Treatment Outcome