The Therapeutic Strategy and Outcome of Endovascular Therapy for Acute Stroke with Cerebral Proximal Artery Occlusion due to Atherosclerotic Artery Stenosis

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Objective: While intracranial mechanical thrombectomy has been established as a treatment, atherothrombotic brain infarction due to stenosis of major cerebral arteries is occasionally difficult to treat as severe stenosis persists after recanalization, eventually requiring percutaneous transluminal angioplasty (PTA) or stent placement. The contents and results of mechanical thrombectomy for atherothrombotic brain infarction that we have encountered are presented.

Methods: The subjects were 17 patients diagnosed with atherothrombotic brain infarction among the 99 patients with cerebral infarction accompanied by major intracranial artery occlusion treated at our hospital during the 30 months from January 2014 and June 2016. Recanalization graded as Thrombolysis in Cerebral Infarction (TICI) 2b or higher was regarded as effective, and the outcome was evaluated using the modified Rankin Scale (mRS).

Results: The responsible lesion was located at the origin of the internal carotid artery (ICA) in three patients, in the ICA siphon in four patients, middle cerebral artery (MCA) in five patients, vertebral artery (VA) in two patients, and basilar artery (BA) in three patients. Effective recanalization was achieved in 82.4%, the mRS score was 0-2 in 52.9%, and the postoperative mRS score was the same as before treatment in 11.8%.

Conclusion: The outcome of intracranial mechanical thrombectomy for atherothrombotic brain infarction accompanied by major intracranial artery stenosis was favorable in many patients, and aggressive treatment is considered recommendable. In addition, safe and appropriate execution of additional treatments for residual stenotic lesions leads to favorable outcomes.