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Updated: Dec 15, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular Treatment in Patients with Cerebral Artery Occlusion of Three Different Etiologies
Dongwhane Lee1, Deok Hee Lee2, Dae Chul Suh2
1Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Endovascular treatment (EVT) shows similar functional outcomes for intracranial arterial steno-occlusion (ICAS-O) and artery-to-artery embolism (AT-O) compared to cardiac embolism (CA-O). This suggests a potentially extended therapeutic window for ICAS-O and AT-O patients undergoing EVT.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Surgery
Background:
- Endovascular treatment (EVT) efficacy can vary based on the cause of arterial occlusion.
- Understanding etiological differences is crucial for optimizing stroke treatment outcomes.
Purpose of the Study:
- To compare EVT outcomes across different etiologies of ischemic stroke: intracranial arterial steno-occlusion (ICAS-O), artery-to-artery embolism (AT-O), and cardiac embolism (CA-O).
Main Methods:
- Retrospective analysis of 330 ischemic stroke patients undergoing EVT (2012-2017).
- Patients categorized by etiology: CA-O (n=149), ICAS-O (n=63), AT-O (n=49).
- Comparison of clinical data, EVT factors, and 3-month modified Rankin Scale (mRS) outcomes using ordinal logistic regression.
Main Results:
- Cardiac embolism (CA-O) was the most frequent etiology, associated with higher age, NIHSS scores, and hemorrhagic transformation rates.
- Onset-to-recanalization times were shortest for CA-O, followed by AT-O and ICAS-O.
- Successful recanalization, mRS distribution, and favorable 3-month outcomes (mRS 0-2) did not significantly differ among the etiological groups (CA-O: 36.9%, AT-O: 53.1%, ICAS-O: 41.3%).
- Initial NIHSS score independently predicted favorable mRS outcomes.
Conclusions:
- Functional outcomes following EVT for ICAS-O and AT-O are comparable to CA-O.
- The findings suggest a potentially extended therapeutic time window for EVT in patients with ICAS-O and AT-O, despite longer onset-to-recanalization times.
Background And Purpose:
The outcome of endovascular treatment (EVT) may differ depending on the etiology of arterial occlusion. This study aimed to assess the differences in EVT outcomes in patients with intracranial arterial steno-occlusion (ICAS-O), artery-to-artery embolism (AT-O), and cardiac embolism (CA-O).
Methods:
We retrospectively analyzed 330 patients with ischemic stroke who underwent EVT between January 2012 and August 2017. Patients were classified according to the etiology. The clinical data, EVT-related factors, and clinical outcomes were compared. The modified Rankin Scale (mRS) score at 3 months, determined using ordinal logistic regression (shift analysis), was the primary outcome.
Results:
CA-O (n=149) was the most common etiology, followed by ICAS-O (n=63) and AT-O (n=49). Age, initial National Institutes of Health Stroke Scale (NIHSS) score, and rate of hemorrhagic transformation were significantly higher in patients with CA-O compared to AT-O and ICAS-O. The time from onset-to-recanalization was the shortest in the CA-O (356.0 minutes) groups, followed by the AT-O (847.0 minutes) and ICAS-O (944.0 minutes) groups. The rates of successful recanalization, mRS distribution, and favorable outcomes at 3 months (mRS 0-2; CA-O, 36.9%, AT-O, 53.1%; and ICAS-O, 41.3%) did not differ among the three groups. Baseline NIHSS score (odds ratio, 0.87; 95% confidence interval, 0.83 to 0.91) could independently predict a favorable shift in mRS distribution.
Conclusions:
The functional outcomes of ICAS-O and AT-O were similar to those of CA-O, despite the delay in symptom onset-to-recanalization, suggesting that the therapeutic time window may be extended in these patients.
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