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J Stroke Cerebrovasc Dis. 2015 Sep;24(9):2074-80. doi: 10.1016/j.jstrokecerebrovasdis.2015.05.003. Epub 2015 Jul 9.

Endovascular Therapy of Cerebral Arterial Occlusions: Intracranial Atherosclerosis versus Embolism.

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Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea. Electronic address:
Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea.
Departments of Clinical Neurosciences and Radiology, Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.
Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, South Korea.



Treatment strategy for acute arterial occlusions due to intracranial atherosclerotic disease (IAD) may differ from those due to embolism (embolic). The aims were to differentiate and classify angiographically defined occlusion due to IAD versus embolism and identify baseline clinical factors associated with IAD-related occlusion.


Acute ischemic stroke patients with large cerebral artery occlusions on computed tomography angiography who underwent transfemoral cerebral angiography for endovascular treatment were included. Patients were categorized as the embolic (no evidence of focal stenosis after recanalization) or IAD group (significant fixed focal stenosis in the occlusion site, evidenced in the final angiography or during the endovascular treatment procedure) based on transfemoral cerebral angiography findings.


In total, 158 patients were included. The IAD group patients (n = 24) were younger (P = .005), more often male (P < .001) and smokers (P < .001), and had a higher total cholesterol level (P = .001) than patients in the embolic group (n = 134). The posterior circulation was more frequently involved in the IAD group (P = .001). Independent predictors of IAD on multivariable analysis were male sex (odds ratio, 6.42 [95% confidence interval, 1.25-32.97], P = .026), posterior circulation involvement (3.57 [1.09-11.75], P = .036), and high total cholesterol levels (1.02 [1.01-1.03], P = .008).


Male sex, hypercholesterolemia, and posterior circulation involvement are associated with higher likelihood of underlying IAD as the etiology for the intracranial arterial occlusion. In patients with these characteristics, underlying IAD may have to be considered and the endovascular treatment strategy may have to be modified.


Intracranial atherosclerosis; acute ischemic stroke; cerebrovascular disorders; intracranial embolism; thrombectomy; thrombolytic therapy

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