Clinico-radiological features of intracranial atherosclerosis-related large vessel occlusion prior to endovascular...

Area of Science:

• Neurology
• Radiology
• Vascular Medicine

Background:

• Large vessel occlusion (LVO) in stroke treatment requires prompt identification of underlying causes.
• Intracranial atherosclerotic disease (ICAS) is a significant cause of LVO, complicating endovascular treatment (EVT).
• Accurate pre-EVT identification of ICAS-LVO is crucial for optimizing treatment strategies.

Purpose of the Study:

• To identify baseline clinical and radiological features associated with ICAS-LVO.
• To develop a model for prompt identification of ICAS-LVO before EVT.
• To evaluate the diagnostic value of a multivariate logistic regression model for ICAS-LVO detection.

Main Methods:

• Retrospective cross-sectional study of 338 stroke patients undergoing EVT (January 2020 - April 2022).
• Inclusion of anterior LVO involving the intracranial internal carotid artery and middle cerebral artery.
• Analysis of clinical variables, radiological features (including hypoperfusion intensity ratio), and logistic regression modeling to identify ICAS-LVO.

Main Results:

• ICAS-LVO was present in 8.3% of patients (28/338).
• Independent predictors of ICAS-LVO included absence of atrial fibrillation, lower hypoperfusion intensity ratio, symptomatic intracranial artery calcification, proximal occlusion (ICA, MCA-M1), and smoking.
• The developed clinico-radiological model demonstrated high capability in identifying ICAS-LVO (AUC = 0.88).

Conclusions:

• A combination of pre-EVT clinical and radiological features effectively identifies ICAS-LVO.
• This approach facilitates rapid etiological assessment and suggests pathophysiology-based treatment measures.
• Further prospective studies are warranted to validate these findings in diverse patient populations.