Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis

BaiXue Jia; Lei Feng; David S Liebeskind; Xiaochuan Huo; Feng Gao; Ning Ma; Dapeng Mo; Xiaoling Liao; Chunjuan Wang; Xingquan Zhao; Yuesong Pan; Hao Li; Liping Liu; Yilong Wang; Yongjun Wang; Zhong-Rong Miao; EAST Study Group

doi:10.1136/neurintsurg-2017-013489

Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis

J Neurointerv Surg. 2018 Aug;10(8):746-750. doi: 10.1136/neurintsurg-2017-013489. Epub 2017 Dec 4.

Authors

BaiXue Jia¹, Lei Feng², David S Liebeskind³, Xiaochuan Huo¹, Feng Gao¹, Ning Ma¹, Dapeng Mo¹, Xiaoling Liao⁴, Chunjuan Wang⁵, Xingquan Zhao⁴, Yuesong Pan⁶, Hao Li⁷, Liping Liu⁸, Yilong Wang⁹, Yongjun Wang⁹, Zhong-Rong Miao¹; EAST Study Group

Collaborators

EAST Study Group:
Ya Peng, Yibin Cao, Shengli Chen, Meng Zhang, Changchun Jiang, Xiaoxiang Peng, Cunfeng Song, Liping Wei, Qiyi Zhu, Zaiyu Guo, Li Liu, Hang Lin, Hua Yang, Wei Wu, Hui Liang, Anding Xu, Kangning Chen

Affiliations

¹ Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
² Department of Radiology, Kaiser Permanente Medical Center, Los Angeles, USA.
³ Department of Neurology, Neurovascular Imaging Research Core, UCLA, Los Angeles, California, USA.
⁴ Department of Vascular Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁵ Department of Neurology, Tiantan Clinical Trial and Research Center for Stroke, Beijing Tiantan Hospital, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
⁶ Department of Neurology, Tiantan Clinical Trial and Research Center for Stroke, Beijing Tiantan Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
⁷ Department of Neurology, China National Clinical Research Center for Neurological Diseases, Tiantan Clinical Trialand Research Center for Stroke, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁸ Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
⁹ Department of Vascular Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Tiantan Clinical Trial and Research Center for Stroke, Center of Stroke, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.

PMID: 29203731
DOI: 10.1136/neurintsurg-2017-013489

Abstract

Objective: To investigate the safety and efficacy of mechanical thrombectomy plus rescue therapy for intracranial large artery occlusion (ILAO) with underlying intracranial atherosclerosis (ICAS).

Methods: Patients enrolled in the intervention group of EAST (Endovascular Therapy for Acute ischemic Stroke Trial) were analyzed. For underlying ICAS identified during the stent retrieval procedure, rescue treatment was required for those with (1) a degree of arterial stenosis >70% or (2) any degree of arterial with blood flow impairment or (3) evidence of re-occlusion. Outcomes were compared between the ICAS group and the embolic group. Multivariate logistic regression was performed to determine independent predictors of functional independence at 90 days.

Results: Among the 140 patients included in the analysis, underlying ICAS was identified in 47 (34%), and 30 patients (21.4%) were considered to be eligible to receive rescue treatment. Of the 30 patients, 27 (90%) actually received rescue therapy. Recanalization rate (95.7% vs 96.8%, P=0.757) and functional independence at 90 days (63.8% vs 51.6%, P=0.169) were comparable between the ICAS group and the embolic group. No significant difference in symptomatic hemorrhage (4.3% vs 4.3%, P=1.000) or death (12.8% vs 12.9%, P=0.982) was found between the two groups. National Institutes of Health Stroke Scale score at presentation (OR=0.865, 95% CI 0.795 to 0.941; P=0.001) and modified Thrombolysis in Cerebral Infarction after the procedure (OR=2.864, 95% CI 1.018 to 8.061; P=0.046) were independently associated with functional independence at 90 days.

Conclusions: Mechanical thrombectomy is safe in patients with ILAO with underlying ICAS. By employing a standard rescue therapy, favorable outcomes could be achieved in such patients.

Clinical trial registration: NCT02350283 (Post-results).

Keywords: atherosclerosis; stenosis; stent; stroke; thrombectomy.

Publication types

Controlled Clinical Trial
Multicenter Study

MeSH terms

Aged
Brain Ischemia / diagnostic imaging
Brain Ischemia / epidemiology
Brain Ischemia / therapy*
Cerebrovascular Disorders / diagnostic imaging
Cerebrovascular Disorders / epidemiology
Cerebrovascular Disorders / therapy*
Cohort Studies
Endovascular Procedures / methods*
Female
Humans
Intracranial Arteriosclerosis / diagnostic imaging
Intracranial Arteriosclerosis / epidemiology
Intracranial Arteriosclerosis / therapy*
Male
Middle Aged
Prospective Studies
Stents
Stroke / diagnostic imaging
Stroke / epidemiology
Stroke / therapy*
Thrombectomy / methods*
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT02350283