RT Journal Article
SR Electronic
T1 Optimal Endovascular Therapy Technique for Isolated Intracranial Atherothrombotic Stroke-Related Large-Vessel Occlusion in the Acute-to-Subacute Stage
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1692
OP 1700
DO 10.3174/ajnr.A8399
VO 45
IS 11
A1 Beppu, Mikiya
A1 Uchida, Kazutaka
A1 Sakai, Nobuyuki
A1 Yamagami, Hiroshi
A1 Toyoda, Kazunori
A1 Matsumaru, Yuji
A1 Matsumoto, Yasushi
A1 Todo, Kenichi
A1 Hayakawa, Mikito
A1 Shindo, Seigo
A1 Ota, Shinzo
A1 Morimoto, Masafumi
A1 Takeuchi, Masataka
A1 Imamura, Hirotoshi
A1 Ikeda, Hiroyuki
A1 Tanaka, Kanta
A1 Ishihara, Hideyuki
A1 Kakita, Hiroto
A1 Sano, Takanori
A1 Araki, Hayato
A1 Nomura, Tatsufumi
A1 Sakakibara, Fumihiro
A1 Shirakawa, Manabu
A1 Yoshimura, Shinichi
A1 for the RESCUE AT-LVO Investigators
YR 2024
UL http://www.ajnr.org/content/45/11/1692.abstract
AB BACKGROUND AND PURPOSE: Reocclusion after treatment is a concern in endovascular therapy for isolated intracranial atherothrombotic stroke-related large-vessel occlusion (AT-LVO). However, the optimal endovascular therapy technique for AT-LVO has not yet been investigated. This study evaluated the optimal endovascular therapy technique for AT-LVO in a real-world setting.MATERIALS AND METHODS: We conducted a historical, multicenter registry study at 51 centers that enrolled patients with AT-LVO. We divided the patients into 3 groups based on the endovascular therapy technique: mechanical thrombectomy alone, percutaneous transluminal angioplasty (PTA), and stent deployment. Mechanical thrombectomy alone was classified into the mechanical thrombectomy-only group; PTA and mechanical thrombectomy–PTA, into the PTA group; and mechanical thrombectomy–stent deployment, mechanical thrombectomy–PTA–stent deployment, PTA–stent deployment, and stent deployment–only into the stent group. The primary outcome was incidence of reocclusion of the treated vessels within 90 days of endovascular therapy completion.RESULTS: We enrolled 770 patients and analyzed 509 patients. The rates in the mechanical thrombectomy-only, PTA, and stent deployment groups were 40.7%, 44.4%, and 14.9%, respectively. Incidence rate of residual stenosis >70% of final angiography was significantly higher in the mechanical thrombectomy-only group than in the PTA and stent deployment groups (mechanical thrombectomy-only versus PTA versus stent deployment: 34.5% versus 26.3% versus 13.2%, P = .002). Reocclusion rate was significantly lower in the PTA group than in the mechanical thrombectomy-only group (adjusted hazard ratio, 0.48; 95% CI, 0.29–0.80). Of the patients, 83.5% experienced reocclusion within 10 days after endovascular therapy. Alarmingly, a substantial subset (approximately 62.0%) of patients experienced reocclusion within 2 days of endovascular therapy. Incidence of mRS scores of 0–2 ninety days after endovascular therapy was not significantly different among the 3 groups. Incidences of symptomatic intracranial hemorrhage, any other intracranial hemorrhage, and death were not significantly different.CONCLUSIONS: Incidence rate of reocclusion was significantly lower in the PTA group than in the mechanical thrombectomy-only group. We found no meaningful difference in reocclusion rates between the stent deployment and mechanical thrombectomy-only groups. In Japan, glycoprotein IIb/IIIa inhibitors are not reimbursed. Therefore, PTA might be the preferred choice for AT-LVOs due to the higher reocclusion risk with mechanical thrombectomy-only. Reocclusion was likely to occur within 10 days, particularly within 2 days post-endovascular therapy.AT-LVOatherothrombotic stroke-related large-vessel occlusionDAPTdual antiplatelet therapyEVTendovascular treatmentGPglycoproteinHRhazard ratioICHintracranial hemorrhageLVOlarge-vessel occlusionMTmechanical thrombectomyPTApercutaneous transluminal angioplastyStentstent deploymentTAPTtriple antiplatelet therapy