2022 Volume 50 Issue 1 Pages 14-19
Background: Neurothrombectomy is widely accepted as the standard treatment for acute ischemic stroke caused by a large-vessel occlusion. However, the optimal management of large-vessel occlusion resulting from intracranial atherosclerotic disease remains to be determined.
Methods: A retrospective analysis of eight patients treated at two institutions between April 2012 and July 2019 was conducted. Their demographic, clinical, and radiographic presentations and clinical outcomes were studied. The functional outcomes were assessed using the modified Rankin Scale after rehabilitation or discharge.
Results: Five patients were men and three were women. The occluded vessels were the middle cerebral artery in four patients and the basilar artery in the other four. The median age was 75.5 years (range 57-93 years). Neurothrombectomy was performed in five patients as first-line treatment. In two patients, complete recanalization was achieved by intravenous thrombolysis alone. In one patient, percutaneous transluminal angioplasty was performed without successful recanalization. Re-occlusion or flow stagnation after successful recanalization occurred in four patients (57%) within 3 days, in all of whom an intracranial stent was permanently placed. In another patient with basilar artery atherosclerosis, percutaneous transluminal angioplasty for residual stenosis after successful neurothrombectomy was performed on day 19 of the hospital stay. Favorable outcomes were achieved in five (62.5%) patients, and mortality was observed in two of four patients with basilar artery occlusion.
Conclusions: Early re-occlusion within 72 hours after successful recanalization via neurothrombectomy or intravenous thrombolysis was common in patients with intracranial atherosclerosis-related occlusion. A rescue stent procedure seems reasonable as the last resort following the failure of standard treatment.
