Direct Stenting of Intracranial Atherosclerosis-related Acute Large Vessel Occlusion

Endovascular reperfusion therapy (ERT) in patients with intracranial atherosclerosis (ICAS)-related acute large vessel occlusion (ALVO) may require different strategies based on the underlying culprit plaque lesion. This study investigated the effectiveness and safety of direct stent placement in ICAS-related ALVO compared with initially attempted mechanical thrombectomy (MT) with or without rescue treatment.

Direct stenting for ICAS-related ALVO was performed in 30 consecutive patients between January 1, 2012, and December 31, 2018. As a control for comparison, MT with or without rescue stenting for patients with ICAS-related ALVO was performed in 73 consecutive patients during the same period. Clinical outcomes were assessed by measuring modified Rankin Scale (mRS) at 90 days.

Patients who underwent direct stenting and those who underwent MT with or without rescue stenting showed no significant differences in baseline characteristics. There was a higher proportion of patients with mRS 0-2 at 90 days in the direct stenting group than in the MT with or without rescue stenting group [24 (80.0%) vs. 34 (46.6%); p = 0.004]. Successful recanalization to modified thrombolysis in cerebral infarction category 2b or 3 was achieved in 93.3% of patients who underwent direct stenting, and in 90.4% of patients who underwent MT with or without rescue stenting.

Direct stenting is an effective and safe option for ICAS-related ALVO. Further studies are needed to confirm that endovascular treatments are effective and safe in patients with ALVO and underlying ICAS.