Abstract T P11: What Clinical Factors Predict An Intracranial Arterial Stenosis Responsible For An Intracranial Larger Artery Occlusion Treated By Endovascular Therapy?

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jin Soo Lee ◽  
Ji Man Hong ◽  
Kyu Sun Lee ◽  
Hong Il Suh ◽  
Andrew M Demchuk
Keyword(s):  
Endovascular Treatment ◽  
Total Cholesterol ◽  
Cerebral Angiography ◽  
Clinical Laboratory ◽  
Total Cholesterol Level ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Focal Stenosis

Objectives: In Asian countries where intracranial arterial stenosis (ICAS) is a common etiology regarding large artery intracranial occlusions in stroke. We sought to identify any clinical, laboratory and baseline imaging variables that may predict ICAS prior to endovascular treatment compared with angiographically-defined embolism (ADE). Methods: Patients were included if they had large cerebral artery occlusion in stroke on CT angiography and undertook transfemoral cerebral angiography, and if their onset to puncture time was within 8 hours. We defined ICAS and ADE by transfemoral cerebral angiography. ICAS was defined as fixed significant (> 50%) focal stenosis in the occlusion site, which could be seen in the final angiography or during the procedure of endovascular treatment. ADE was defined by no focal stenosis was evident after some recanalization achieved. Patients were excluded if their cause of stroke was associated or combined with other etiologies. Results: Finally, a total of 157 patients were included for this study. Table shows comparisons of clinical laboratory and imaging characteristics between ICAS and ADE groups. Patients in ICAS group were younger and male-predominant than in those in ADE group. Dyslipidemia and smokers were more frequent in ICAS group. Total cholesterol level was higher in ICAS group than in ADE group. Compared to ADE an ICAS was much more common in the posterior circulation 11/30 versus only 12/127 in the anterior circulation (p<0.001). Independent predictors of ICAS on multivariable analysis were male gender (odds ratio 6.34 [95% CI, 1.23-32.85], p=0.028), posterior circulation involvement (5.37 [1.62-17.82], p=0.006) and total cholesterol level (1.02 [1.004-1.033], p=0.012). Conclusion: The neurointerventionalist should prepare for the possibility of ICAS when performing endovascular treatment especially with posterior circulation occlusions in a Korean population.

scholarly journals Endovascular treatment for intracranial arterial stenosis

Nosotchu ◽  
2015 ◽  
Vol 37 (4) ◽  
pp. 241-247
Author(s):  
Shigeru Miyachi ◽  
Takumi Asai
Keyword(s):  
Endovascular Treatment ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis

scholarly journals Prevalence and Risk Factors Comparison of Anterior and Posterior Intracranial Arterial Stenosis

2022 ◽  
Vol 2022 ◽  
pp. 1-8
Author(s):  
Yan Zhao ◽  
Beibei Liu ◽  
Chunxiu Wang ◽  
Shaochen Guan ◽  
Chunxiao Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Population Data ◽  
Posterior Circulation ◽  
Arterial Stenosis ◽  
Vascular Lesions ◽  
Vascular Risk ◽  
Intracranial Arterial Stenosis ◽  
Anterior Circulation ◽  
Logistics Regression ◽  
Atherosclerotic Stenosis

The prevalence and risk factors of intracranial atherosclerotic stenosis (ICAS) located in the anterior circulation (AC) and posterior circulation (PC) has been scarcely noted in the general population. We aimed to determine ICAS prevalence and risk factor profile of AC and PC in a representative population. Data were from the China Hypertension Survey of Beijing. In total, 4800 people aged 35 years or older were enrolled in this subsurvey for ICAS, and 3954 participants were eligible for analysis. ICAS was assessed by transcranial Doppler. The prevalence of ICAS in AC was much greater than that in PC (11.9% vs. 4.2%), and subjects with ICAS in PC were 3.9 years older than those with ICAS in AC. Multivariable logistics regression showed that the odds of hypertension and diabetes increased by 79% (OR: 1.79, 95% CI: 1.40–2.27) and 35% (OR: 1.35, 95% CI: 1.04–1.75) in those with AC vascular lesions and by 3.35 times (OR: 3.35, 95% CI: 2.49–4.50) and 71% (OR: 1.71, 95% CI: 1.19–2.46) in those with PC vascular lesions compared with those without vascular lesions. Most modifiable vascular risk factors for ICAS appeared to exert similar magnitudes of risk for PC to AC lesions.

Posterior circulation collateral flow modifies the effect of thrombectomy on outcome in acute basilar artery occlusion

2021 ◽  
pp. 174749302110522
Author(s):  
Gabriel Broocks ◽  
Tobias D Faizy ◽  
Lukas Meyer ◽  
Maximilian Groffmann ◽  
Sarah Elsayed ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Poor Outcomes ◽  
The Impact

Background In basilar artery occlusion stroke, the impact of the collateral circulation on infarct progression in the context of endovascular treatment is yet poorly studied. Aim This study investigates the impact of the posterior circulation collateral score (PCCS) on functional outcome according to the extent of early ischemic changes and treatment. We hypothesized that the presence of collaterals, quantified by the PCCS, mediates the effect of endovascular treatment on functional outcome in patients with acute basilar artery occlusion. Methods In this multicenter observational study, patients with basilar artery occlusion and admission computed tomography were analyzed. At baseline, Posterior circulation Acute Stroke Prognosis Early Computed Tomography score (pcASPECTS) was assessed and PCCS was quantified using an established 10-point grading system. Logistic regression analyses were performed to identify factors associated with good functional outcome (modified Rankin Scale scores 0–2 at day 90). Results A total of 151 patients were included, of which 112 patients (74%) underwent endovascular treatment. In patients with a better PCCS (>5), the rate of good outcome was significantly higher (55% vs. 11%; p = 0.001). After adjusting for PCCS, vessel recanalization was significantly associated with improved functional outcome (aOR: 4.53, 95%CI: 1.25–16.4, p = 0.02), while there was no association between recanalization status and outcome in univariable analysis. Patients with low pcASPECTS generally showed very poor outcomes (mean modified Rankin Scale score 5.3, 95%CI: 4.9–5.8). Conclusion PCCS modified the effect of recanalization on functional outcome, particularly in patients with less pronounced ischemic changes in admission computed tomography. These results should be validated to improve patient selection for endovascular treatment in basilar artery occlusion, particularly in uncertain indications, or to triage patients at risk for very poor outcomes.

scholarly journals Endovascular recanalization of symptomatic non–acute intracranial artery occlusion: Procedural and mid-term clinical outcomes in the anterior circulation

2019 ◽  
Vol 25 (4) ◽  
pp. 380-389
Author(s):  
Zhen Yu Jia ◽  
Yun Sun Song ◽  
Jae Jon Sheen ◽  
Joong Goo Kim ◽  
Deok Hee Lee
Keyword(s):  
Endovascular Treatment ◽  
Arterial Occlusion ◽  
Neurological Status ◽  
Artery Occlusion ◽  
Final Outcome ◽  
Arterial Stenosis ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Proper Patient Selection

Objective Symptomatic non–acute intracranial arterial occlusion (NAICO) is not uncommon. We report a single-center experience of the feasibility and safety of endovascular treatment of anterior circulation NAICO and summarize the outcomes of patient groups with successful or failed recanalization. Methods Patients who underwent endovascular therapy for intracranial arterial stenosis between January 2010 and May 2017 were retrospectively reviewed. Thirty-eight patients with symptomatic NAICO (symptom onset > 24 hours) in the anterior circulation were identified. Results Successful recanalization was achieved in 76.3% of patients (29/38). Intraprocedural events occurred in 10.5% (4/38), including intima dissection ( n = 1), parent artery rupture ( n = 1) and acute in-stent thrombosis ( n = 2). Mean follow-up duration after successful recanalization was 36.5 months. One patient died 68 days after the procedure because of a newly developed posterior circulation stroke. Acute reocclusion was observed in two patients (6.7%); subacute or delayed reocclusion was observed in three patients (10%). Good final outcome (modified Rankin Scale score ≤ 2) was achieved in 25 of 28 patients (89.3%) at three months. Mean follow-up duration of the nine patients with failed recanalization was 41.4 months. Three patients underwent extra–intracranial bypass for worsening symptoms. The other six patients showed stable or improved neurological status with antiplatelet medications. Good final outcome was achieved in eight of nine patients (88.9%) at three months. Conclusions Endovascular revascularization can be a viable option with an acceptable safety profile in selected patients with symptomatic NAICO in the anterior circulation. Further characterization of aborted cases would facilitate proper patient selection for endovascular treatment.

Using the Region of Interest from Time-of-Flight Magnetic Resonance Angiography to Differentiate Between Intracranial Arterial Dissection and True Atherosclerotic Stenosis

2019 ◽  
Vol 47 (1-2) ◽  
pp. 8-14 ◽  
Author(s):  
Jung Won Hwang ◽  
Jin-Man Jung ◽  
Jae Hyung Cha ◽  
Il Eok Jung ◽  
Moon Ho Park ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Time Of Flight ◽  
Region Of Interest ◽  
Arterial Stenosis ◽  
Arterial Dissection ◽  
Intracranial Arterial Stenosis ◽  
Tof Mra ◽  
Significant Difference ◽  
Focal Stenosis

Background: Noncontrast three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is commonly used to examine intracranial arterial stenosis, although it can be difficult to identify the etiology of the stenosis. Our aim was to determine the effectiveness of 3D TOF MRA in differentiating an intracranial arterial dissection from atherosclerosis. Methods: During 2015–2017, 356 patients had confirmed intracranial arterial stenosis based on high resolution-magnetic resonance imaging. This study ultimately included 51 patients with severe focal stenosis that was caused by dissection and atherosclerosis. We compared the dissection group with the atherosclerotic narrowing group by measuring the region-of-interest (ROI) values 3 mm proximal and 3 mm distal from sites of severe focal stenosis. Results: A significant difference was observed between the median ROI difference values in the dissection group (n = 18) and the atherosclerosis group (n = 33; 35.6 [20.9–78.4] vs. 165.5 [99.8–328.5]; p < 0.001). A receiver operating characteristic curve was prepared to distinguish between dissection and atherosclerosis using the ROI difference values. The area under the curve was 0.919 (sensitivity 75.8%, specificity 94.4%). The optimal cutoff value for using ROI to distinguish between dissection and atherosclerosis was found to be 99.0 based on the Youden’s index. Conclusion: The ROI difference value from 3D TOF MRA could help distinguish between dissection and atherosclerosis. If the ROI difference value from 3D TOF MRA is small (< 99.0), detailed testing should be performed to identify dissection.

scholarly journals Mechanical Thrombectomy in Basilar Artery Occlusion

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2045-2050 ◽  
Author(s):  
Hyo Sung Kwak ◽  
Jung Soo Park
Keyword(s):  
Computed Tomography ◽  
Endovascular Treatment ◽  
Scale Score ◽  
Basilar Artery ◽  
Odds Ratio ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
National Institutes Of Health ◽  
Basilar Artery Occlusion

Background and Purpose: Basilar artery occlusion (BAO) is associated with a high risk of disability and mortality. The objective of this study was to investigate prognostic factors in patients with acute basilar artery occlusion treated with mechanical thrombectomy, focusing on collateral status and recanalization time from symptom onset. Methods: Eligible patients from January 2012 to October 2019 who underwent endovascular treatment due to acute BAO were reviewed. The baseline posterior circulation collateral status was assessed with the basilar artery on computed tomography angiography score and posterior circulation collateral score. Good outcomes were defined as a modified Rankin Scale score of ≤2 at 3 months and successful recanalization as Thrombolysis in Cerebral Infarction grades 2b, 3. The associations between baseline and clinical parameters and favorable outcomes were evaluated with logistic regression. Results: Our sample included a total of 81 eligible patients (49 males, mean age 70.3 years) with a median baseline and discharge National Institutes of Health Stroke Scale score of 12. Patients with good outcomes showed a lower baseline National Institutes of Health Stroke Scale score, a greater proportion of distal BAO, and a higher basilar artery on computed tomography angiography and posterior circulation collateral score ( P <0.001). According to subgroup analysis of patients within and over 6 or 12 hours, the time from symptom onset to recanalization was not correlated with good outcomes. Multivariable logistic analysis showed baseline National Institutes of Health Stroke Scale <15 (odds ratio, 8.49 [95% CI, 2.01–35.82]; P =0.004), posterior circulation collateral score ≥6 (odds ratio, 3.79 [95% CI, 1.05–13.66]; P =0.042), and distal BAO (odds ratio, 3.67 [95% CI, 1.10–12.26]; P =0.035) were independent predictors of good outcomes. Conclusions: This study suggested that good collateral circulation and distal BAO are independent predictors of clinical outcome after endovascular treatment in patients with acute BAO. In particular, patients with good initial collateral status and distal BAO may consider endovascular treatment even if the treatment is started beyond the standard time limits.

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