The meaning of non-culprit stenosis in hyperacute stroke with large vessel occlusion

To diagnose atherosclerotic occlusion mechanism in acute ischemic stroke patients with large vessel occlusion prior to revascularization therapy is challenging. The aim was to verify the relationship between atherosclerotic occlusion and non-culprit stenosis detected in urgent neuroimaging prior to interventional procedure.

This study collected hyperacute stroke with large vessel occlusion, who underwent revascularization therapy (intravenous thrombolysis, thrombectomy, or both). An atherosclerotic occlusion was defined as an occlusion that did not recanalize or had residual stenosis at the initially occluded lesion, ensured in the second angiographic imaging performed after 1 week. The remaining patients who did not fulfill the definition of atherosclerotic occlusion was classified as embolic occlusion. A non-culprit stenosis was defined as a ≥ 50%-99% stenosis located other than the culprit occluded artery. Logistic regression analyses were performed to determine the factors independently associated with atherosclerotic occlusion.

A total of 162 patients (104 men, median age 76 years old) were enrolled in our study. Forty one patients (25%) was atherosclerotic occlusion. Non-culprit stenosis was frequently observed in the atherosclerotic occlusion group than the embolic occlusion group (68% vs. 26%, P < 0.001). The presence of non-culprit stenosis was independently associated with atherosclerotic occlusion (OR, 11.00; 95% CI, 3.96-30.52; P < 0.001).

In hyperacute stroke receiving endovascular therapy, non-culprit stenosis identification may be needed in order to perform an adequate revascularization, especially for atherosclerotic occlusion.