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Ischemic Stroke
Original research
Mechanical thrombectomy and rescue therapy for intracranial large artery occlusion with underlying atherosclerosis
  1. BaiXue Jia1,
  2. Lei Feng2,
  3. David S Liebeskind3,
  4. Xiaochuan Huo1,
  5. Feng Gao1,
  6. Ning Ma1,
  7. Dapeng Mo1,
  8. Xiaoling Liao4,
  9. Chunjuan Wang5,
  10. Xingquan Zhao4,
  11. Yuesong Pan6,
  12. Hao Li7,
  13. Liping Liu8,
  14. Yilong Wang9,
  15. Yongjun Wang9,
  16. Zhong-Rong Miao1
  17. on behalf of the EAST Study Group
    1. 1 Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
    2. 2 Department of Radiology, Kaiser Permanente Medical Center, Los Angeles, USA
    3. 3 Department of Neurology, Neurovascular Imaging Research Core, UCLA, Los Angeles, California, USA
    4. 4 Department of Vascular Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    5. 5 Department of Neurology, Tiantan Clinical Trial and Research Center for Stroke, Beijing Tiantan Hospital, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
    6. 6 Department of Neurology, Tiantan Clinical Trial and Research Center for Stroke, Beijing Tiantan Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
    7. 7 Department of Neurology, China National Clinical Research Center for Neurological Diseases, Tiantan Clinical Trialand Research Center for Stroke, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    8. 8 Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
    9. 9 Department of Vascular Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Tiantan Clinical Trial and Research Center for Stroke, Center of Stroke, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
    1. Correspondence to Dr Zhong-Rong Miao, Beijing Tiantan Hospital, Capital Medical University, No.6, Tiantan Xili, Dongcheng district, Beijing 100050, China; zhongrongm{at}163.com

    Abstract

    Objective To investigate the safety and efficacy of mechanical thrombectomy plus rescue therapy for intracranial large artery occlusion (ILAO) with underlying intracranial atherosclerosis (ICAS).

    Methods Patients enrolled in the intervention group of EAST (Endovascular Therapy for Acute ischemic Stroke Trial) were analyzed. For underlying ICAS identified during the stent retrieval procedure, rescue treatment was required for those with (1) a degree of arterial stenosis >70% or (2) any degree of arterial with blood flow impairment or (3) evidence of re-occlusion. Outcomes were compared between the ICAS group and the embolic group. Multivariate logistic regression was performed to determine independent predictors of functional independence at 90 days.

    Results Among the 140 patients included in the analysis, underlying ICAS was identified in 47 (34%), and 30 patients (21.4%) were considered to be eligible to receive rescue treatment. Of the 30 patients, 27 (90%) actually received rescue therapy. Recanalization rate (95.7% vs 96.8%, P=0.757) and functional independence at 90 days (63.8% vs 51.6%, P=0.169) were comparable between the ICAS group and the embolic group. No significant difference in symptomatic hemorrhage (4.3% vs 4.3%, P=1.000) or death (12.8% vs 12.9%, P=0.982) was found between the two groups. National Institutes of Health Stroke Scale score at presentation (OR=0.865, 95% CI 0.795 to 0.941; P=0.001) and modified Thrombolysis in Cerebral Infarction after the procedure (OR=2.864, 95% CI 1.018 to 8.061; P=0.046) were independently associated with functional independence at 90 days.

    Conclusions Mechanical thrombectomy is safe in patients with ILAO with underlying ICAS. By employing a standard rescue therapy, favorable outcomes could be achieved in such patients.

    Clinical trial registration NCT02350283 (Post-results).

    • atherosclerosis
    • stenosis
    • stent
    • stroke
    • thrombectomy

    https://doi.org/10.1136/neurintsurg-2017-013489

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      Footnotes

      • Contributors BJ: analysis and interpretation of data, drafting the manuscript. LF, XH: analysis and interpretation of data, critical revision of manuscript for intellectual content. DL, YiW: study concept and design, critical revision of manuscript for intellectual content. FG, NM, DM: acquisition, analysis, and interpretation of data. NM, LL,XL:acquisition of data, analysis and interpretation of data. CW, XZ, YoW: study concept and design, study supervision. YP, HL: analysis and interpretation of data, study supervision. Z-RM: study supervision,study concept and design, critical revision of manuscript for intellectual content.

      • Funding This work was supported by National Science and Technology Major Project of China grant numbers 2011BAI08B02, 2015BAI12B04, and 2015BAI12B02.

      • Competing interests None declared.

      • Patient consent Obtained.

      • Ethics approval Ethics committee of Beijing Tiantan Hospital.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Collaborators Ya Peng, Yibin Cao, Shengli Chen, Meng Zhang, Changchun Jiang, Xiaoxiang Peng, CunfengSong, Liping Wei, Qiyi Zhu, Zaiyu Guo, Li Liu, Hang Lin, Hua Yang, Wei Wu, Hui Liang, Anding Xu, Kangning Chen