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J Stroke. 2017 May;19(2):143-151. doi: 10.5853/jos.2017.00626. Epub 2017 May 31.

Diagnostic and Therapeutic Strategies for Acute Intracranial Atherosclerosis-related Occlusions.

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Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.
Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Korea.


Intracranial atherosclerosis-related occlusion (ICAS-O) is frequently encountered at the time of endovascular revascularization treatment (ERT), especially in Asian countries. However, because baseline angiographic findings are similar between ICAS-O and embolism-related occlusion (EMB-O), it is difficult to differentiate the etiologies before the ERT procedure. Moreover, despite successful randomized trials on ERT, results from studies examining the optimal treatment protocol in ICAS-O patients remain unclear. In this review, we describe the clinical and imaging factors that may possibly differentiate ICAS-O from EMB-O. We will also discuss some current hurdles for treating ICAS-O in the hyperacute period and suggest the optimal ERT strategy for ICAS-O patients.


Diagnosis; Endovascular procedures; Intracranial arteriosclerosis; Intracranial embolism; Intracranial thrombosis; Therapy

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