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J Neurosurg. 2018 Jun 1:1-8. doi: 10.3171/2018.1.JNS172350. [Epub ahead of print]

Endovascular treatment for emergent large vessel occlusion due to severe intracranial atherosclerotic stenosis.

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Departments of1Neurosurgery.
4Radiology, and.
Departments of2Radiology and.
3Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea.
5Neurology, School of Medicine, Kyungpook National University, Daegu; and.


OBJECTIVEThe optimal treatment strategy for patients with emergent large vessel occlusion (ELVO) due to underlying severe intracranial atherosclerotic stenosis (ICAS) is unclear. The purpose of this study was to compare treatment outcomes from intracranial angioplasty with or without stenting and intraarterial infusion of a glycoprotein IIb/IIIa inhibitor in patients with ELVO due to severe ICAS, and to investigate predictors of outcome after endovascular therapy in such patients.METHODSA total of 140 consecutive patients with ELVO attributable to severe ICAS underwent endovascular therapy at two stroke centers (A and B). Intracranial angioplasty/stenting was primarily performed at center A and intraarterial infusion of glycoprotein IIb/IIIa inhibitor (tirofiban) at center B. Data from both centers were prospectively collected into a database and retrospectively analyzed.RESULTSOverall, successful reperfusion was achieved in 95% (133/140) of patients and a good outcome in 60% (84/140). The mortality rate was 7.9%. Symptomatic hemorrhage occurred in 1 patient. There were no significant differences in the rates of successful reperfusion, symptomatic hemorrhage, 3-month modified Rankin scale score 0-2, and mortality between the two centers. Multivariate logistic regression analysis revealed the only independent predictor of good outcome was a history of previous stroke or transient ischemic attack (TIA) (odds ratio 0.254, 95% confidence interval 0.094-0.689, p = 0.007).CONCLUSIONSBoth intracranial angioplasty/stenting and intraarterial infusion of a glycoprotein IIb/IIIa inhibitor are effective and safe in the treatment of underlying severe ICAS in acute stroke patients with ELVO. In addition, a lack of a history of stroke/TIA was the only independent predictor of good outcome after endovascular therapy in such patients.


DWI = diffusion weighted imaging; ELVO = emergent large vessel occlusion; ICA = internal carotid artery; ICAS = intracranial atherosclerotic stenosis; IQR = interquartile range; IV = intravenous; MCA = middle cerebral artery; NIHSS = National Institutes of Health Stroke Scale; TIA = transient ischemic attack; WASID = Warfarin-Aspirin Symptomatic Intracranial Disease; atherosclerosis; cerebral infarction; intracranial; m-TICI = modified treatment in cerebral infarction; mRS = modified Rankin scale; percutaneous transluminal angioplasty; rt-PA = recombinant tissue plasminogen activator; thrombectomy; vascular disorders


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