Related Experiment Video
Updated: Jan 31, 2026
Monitoring the Wall Mechanics During Stent Deployment in a Vessel
Published on: May 8, 2012
Primary angioplasty/stenting versus mechanical thrombectomy as the initial approach for underlying ICAD-LVO: a
Shuai Mi1, Lin Chen1, Xianhua Hou1
1Department of Neurology, The First Affiliated Hospital (Southwest Hospital), Army Medical University, Chongqing, China.
Insights
For intracranial atherosclerotic disease-related large vessel occlusion (ICAD-LVO), angioplasty/stenting (AS) as an initial strategy improved 90-day functional independence compared to mechanical thrombectomy (MT). This approach demonstrated comparable safety, supporting etiology-specific endovascular treatments.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Radiology
Background:
- Intracranial atherosclerotic disease-related large vessel occlusion (ICAD-LVO) is a significant cause of stroke, particularly in Asian populations.
- Existing guidelines for mechanical thrombectomy (MT) in large vessel occlusion (LVO) lack etiological stratification, leaving optimal strategies for ICAD-LVO undefined.
- The dynamic nature of ICAD-LVO, including intraprocedural reocclusion and stenotic pathology, presents unique challenges for endovascular treatment.
Purpose of the Study:
- To compare the efficacy and safety of angioplasty/stenting (AS) versus mechanical thrombectomy (MT) as initial endovascular strategies for ICAD-LVO.
- To evaluate the impact of initial endovascular approach on 90-day functional independence in patients with ICAD-LVO.
- To assess secondary outcomes including successful recanalization, symptomatic intracranial hemorrhage (SICH), and mortality.
Main Methods:
- A multicenter retrospective cohort study involving 161 patients with ICAD-LVO undergoing endovascular therapy.
- Patients were stratified into two groups based on the initial strategy: angioplasty/stenting (AS, n=94) or mechanical thrombectomy (MT, n=67).
- Primary outcome was 90-day functional independence (modified Rankin Scale [mRS] score 0-2); secondary outcomes included recanalization, SICH, and mortality.
Main Results:
- The initial AS group (63.8%) demonstrated significantly higher rates of 90-day functional independence compared to the MT group (47.8%; adjusted OR=2.886, p=0.011).
- The AS approach was associated with a reduced need for rescue therapy (24.5% vs. 55.2%).
- No significant differences were observed in successful recanalization rates (96.8% vs. 91.0%), SICH (13.8% vs. 13.4%), or 90-day mortality (14.9% vs. 13.4%) between the groups.
Conclusions:
- Primary angioplasty/stenting as an initial strategy for ICAD-LVO is associated with superior clinical efficacy, specifically higher rates of functional independence.
- The AS approach offers a comparable safety profile to MT regarding recanalization, SICH, and mortality.
- These findings advocate for etiology-specific endovascular strategies in ICAD-LVO, warranting confirmation through prospective randomized controlled trials.
Objective:
Intracranial atherosclerotic disease-related large vessel occlusion (ICAD-LVO) is a prevalent stroke subtype among Asian populations. Characterized by dynamic intraprocedural reocclusion and underlying stenotic pathology, this condition poses distinct challenges for acute endovascular management. Contemporary guidelines universally recommend mechanical thrombectomy (MT) as first-line recanalization therapy for large vessel occlusion (LVO); however such recommendations derive predominantly from studies without etiological stratification. Consequently, optimal initial endovascular strategies for ICAD-LVO remain undefined despite its epidemiological significance in Asian cohorts.
Methods:
In this multicenter retrospective cohort study, 161 patients with underlying ICAD-LVO who underwent endovascular therapy (June 2022-December 2024) were stratified by initial strategy: angioplasty/stenting (AS group, n = 94) or mechanical thrombectomy (MT group, n = 67). The primary outcome was 90-day functional independence (modified Rankin Scale [mRS] score 0-2). Secondary outcomes included successful recanalization (mTICI 2b-3), symptomatic intracranial hemorrhage (SICH), and mortality.
Results:
Among 161 included patients (94 AS vs. 67 MT), baseline characteristics were balanced except for a higher prevalence of hyperlipidemia (p = 0.041), progressive stroke (p < 0.001), and tirofiban administration (p = 0.043) in the AS group. The initial AS approach achieved significantly higher rates of functional independence (63.8% vs. 47.8%; adjusted OR = 2.886, 95% CI: 1.290-6.736, p = 0.011) and reduced the need for rescue therapy (24.5% vs. 55.2%). Rates of successful recanalization (96.8% vs. 91.0%, p = 0.155), SICH (13.8% vs. 13.4%, p = 0.985), and 90-day mortality (14.9% vs. 13.4%, p = 0.784) did not differ significantly.
Conclusion:
In this multicenter retrospective cohort study, primary angioplasty/stenting was associated with superior clinical efficacy compared to mechanical thrombectomy as the initial approach for underlying ICAD-LVO. This approach showed higher rates of 90-day functional independence while maintaining a comparable safety profile. These findings support the concept of etiology-specific endovascular strategies; however, this approach requires confirmation in prospective randomized controlled trials.
Related Concept Videos
02:33Initiation of Translation
First, the initiator tRNA must be selected from the pool of elongator tRNAs by eukaryotic initiation factor 2 (eIF2). The initiator tRNA (Met-tRNAi) has conserved sequence elements including modified bases at...
02:33Initiation of Translation
01:47Transcription Initiation
The promoters and enhancers and their accessory proteins allow tight regulation of...
02:38S-Cdk Initiates DNA Replication
Two states at the origin of replication
In eukaryotes, the initiation of replication occurs at many sites on the chromosomes, called the origins of...
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:47Primary Active Transport