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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Large Vessel Occlusion Stroke due to Intracranial Atherosclerotic Disease: Identification, Medical and Interventional

Adam de Havenon1, Osama O Zaidat2, Sepideh Amin-Hanjani3

  • 1Neurology, Yale University, New Haven, CT (A.d.H., A.B., M.A.).

Stroke
|March 20, 2023
PubMed

Insights

Intracranial atherosclerotic disease causing large vessel occlusion stroke (ICAD-LVO) requires specific management. Early identification and treatment planning are crucial for successful endovascular thrombectomy outcomes in these patients.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Interventional Neurology

Background:

  • Large vessel occlusion stroke (LVO) is frequently caused by intracranial atherosclerotic disease (ICAD-LVO), affecting 10-30% of cases.
  • Patients with ICAD-LVO benefit from endovascular thrombectomy, but face high rates of reocclusion post-procedure.
  • Unique management considerations exist for ICAD-LVO before, during, and after endovascular thrombectomy.

Purpose of the Study:

  • To propose a comprehensive, multistep approach for managing ICAD-LVO.
  • To outline strategies for identification, pretreatment, and post-treatment care in ICAD-LVO patients undergoing endovascular thrombectomy.
  • To synthesize current knowledge on ICAD-LVO management, given the lack of large randomized controlled trials.

Main Methods:

  • Review of observational studies focusing on ICAD-LVO.
  • Synthesis of data on patient factors influencing ICAD-LVO prevalence.
  • Analysis of treatment considerations and outcomes for ICAD-LVO.

Main Results:

  • ICAD-LVO is a significant cause of LVO, influenced by vascular risk factors, race, ethnicity, and age.
  • Endovascular thrombectomy offers functional benefits comparable to other LVO etiologies.
  • High rates of reocclusion (up to 50%) are observed in ICAD-LVO patients post-thrombectomy.

Conclusions:

  • Early identification and tailored treatment planning are essential for optimizing outcomes in ICAD-LVO.
  • A structured approach encompassing identification, pretreatment, thrombectomy, and medical management is proposed.
  • Further research, potentially including dedicated trials, is needed to refine ICAD-LVO treatment strategies.

Keywords:
intracranial atherosclerosismortalityrisk factorsstrokethrombectomy

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