Combination of Rescue Stenting and Antiplatelet Infusion Improved Outcomes for Acute Intracranial Atherosclerosis-Related Large-Vessel Occlusion

• Published in: Frontiers in neurology Vol. 12; p. 608270
• Main Authors: Baek, Jang-Hyun, Jung, Cheolkyu, Kim, Byung Moon, Heo, Ji Hoe, Kim, Dong Joon, Nam, Hyo Suk, Kim, Young Dae, Lim, Eun Hyun, Kim, Jun-Hwee, Kim, Jun Yup, Kim, Jae Hyoung
• Format: Journal Article
• Language: English
• Published: Frontiers Media S.A 05.07.2021
• Subjects: angioplasty; atherosclerosis; endovascular treatment; Neurology; stent; stroke
• ISSN: 1664-2295; 1664-2295
• DOI: 10.3389/fneur.2021.608270

Background and Purpose: Intracranial atherosclerosis-related large-vessel occlusion caused by in situ thrombo-occlusion (ICAS-LVO) has been regarded an important reason for refractoriness to mechanical thrombectomy (MT). To achieve better outcomes for ICAS-LVO, different endovascular strategies should be explored. We aimed to investigate an optimal endovascular strategy for ICAS-LVO. Methods: We retrospectively reviewed three prospective registries of acute stroke underwent endovascular treatment. Among them, patients with ICAS-LVO were assigned to four groups based on their endovascular strategy: (1) MT alone , (2) rescue intracranial stenting after MT failure ( MT-RS ), (3) glycoprotein IIb/IIIa inhibitor infusion after MT failure ( MT-GPI ), and (4) a combination of MT-RS and MT-GPI ( MT-RS + GPI ). Baseline characteristics and outcomes were compared among the groups. To evaluate whether the endovascular strategy resulted in favorable outcome, multivariable analysis was also performed. Results: A total of 184 patients with ICAS-LVO were included. Twenty-four patients (13.0%) were treated with MT alone, 25 (13.6%) with MT-RS, 84 (45.7%) with MT-GPI, and 51 (27.7%) with MT-RS+GPI. The MT-RS+GPI group showed the highest recanalization efficiency (98.0%). Frequency of patent arteries on follow-up (98.0%, p < 0.001) and favorable outcome (84.3%, p < 0.001) were higher in the MT-RS+GPI group than other groups. The MT-RS+GPI strategy remained an independent factor for favorable outcome (odds ratio, 20.4; 95% confidence interval, 1.97–211.4; p = 0.012). Conclusion: Endovascular strategy was significantly associated with procedural and clinical outcomes in acute stroke by ICAS-LVO. A combination of RS and GPI infusion might be an optimal rescue modality when frontline MT fails.