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Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
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Association Between Occlusion Type and Etiology of Acute Intracranial Large Artery Occlusion

Huang Chuming1, Hong Yifan1, Xu Ke1

  • 1Shantou Central Hospital, Shantou, China.

Frontiers in Neurology
|November 16, 2020
PubMed

Insights

Truncal-type occlusion is highly predictive of intracranial atherosclerosis (ICAS) in acute ischemic stroke (AIS) patients. Identifying occlusion type before stent retriever thrombectomy aids in selecting optimal endovascular treatment strategies.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Interventional Neuroradiology

Background:

  • Acute ischemic stroke (AIS) caused by intracranial large artery occlusion requires prompt diagnosis and effective treatment.
  • Differentiating between intracranial atherosclerosis (ICAS) and embolism as the cause of occlusion is crucial for guiding endovascular therapy.
  • Stent retriever (SR) thrombectomy is a common treatment for AIS, necessitating accurate pre-procedural assessment.

Purpose of the Study:

  • To evaluate the diagnostic efficiency of truncal-type versus branching-site occlusion in determining the etiology of intracranial large artery occlusion related AIS.
  • To assess the predictability of truncal-type occlusion for ICAS in AIS patients undergoing SR thrombectomy.

Main Methods:

  • Retrospective analysis of 115 AIS patients with intracranial large artery occlusion who underwent SR thrombectomy.
  • Angiography was used to classify occlusion types (truncal-type vs. branching-site) and determine etiology (ICAS vs. embolism).
  • Diagnostic indicators including AUC, sensitivity, and specificity were calculated for truncal-type occlusion in predicting ICAS.

Main Results:

  • A significant difference in occlusion types was observed between ICAS (93% truncal-type) and embolism (90% branching-site) groups (P < 0.01).
  • Truncal-type occlusion demonstrated high diagnostic efficiency for ICAS, with an AUC of 0.916, sensitivity of 92.86%, and specificity of 90.41%.
  • ICAS was predominantly associated with truncal-type occlusion, while embolism was more frequently linked to branching-site occlusion.

Conclusions:

  • Truncal-type occlusion is a strong indicator of intracranial atherosclerosis (ICAS) in AIS.
  • Pre-procedural determination of occlusion etiology, particularly distinguishing ICAS, is vital for optimizing endovascular treatment strategies.
  • Accurate etiological diagnosis can improve patient outcomes following SR thrombectomy for intracranial large artery occlusion.

Keywords:
intracranial atherosclerosisintracranial large artery occlusionstentstrokethrombectomy

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