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Increased incidence and treatment of intracranial atherosclerotic disease during mechanical thrombectomy is safe, even with an increased number of passes
  1. Marlon Carl Monayao1,
  2. Ahmed A Malik2,
  3. Laurie Preston1,3,
  4. Marlon Carl Monayao Sr1,
  5. Wondwossen Tekle1,3,4,
  6. Ameer E Hassan1,3,4
  1. 1 Department of Clinical Neuroscience Research, Valley Baptist Medical Center-Harlingen, Harlingen, Texas, USA
  2. 2 Neurology, Zeenat Qureshi Stroke Institute, Gainesville, Florida, USA
  3. 3 Neuroscience Department, Valley Baptist Medical Center-Harlingen, Harlingen, Texas, USA
  4. 4 Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
  1. Correspondence to Dr Ameer E Hassan, Department of Neurology, 2101 Pease St, Suite 1D, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen 78550, Texas, USA; ameerehassan{at}


Background The incidence of intracranial atherosclerotic disease (ICAD) in acute ischemic stroke treated with mechanical thrombectomy (MT) is not well defined, and its description may lead to improved stroke devices and rates of first pass success.

Methods A retrospective study was performed on MT patients from 2012 to 2019 at a comprehensive stroke center using chart review and angiogram analysis. Angiograms at the time of MT were reviewed for ICAD, and location and severity were recorded. Patients with ICAD were divided according to ICAD location relative to the large vessel occlusion (LVO) site. Statistical analyses were performed on baseline demographics, comorbidities, MT procedure variables, outcome variables, and their association with ICAD.

Results Of the 533 patients (mean age 70.4 (SD 13.20) years, 43.5% women), 131 (24.6%) had ICAD. There was no significant difference in favorable discharge outcomes (modified Rankin Scale score of 0–2; 23.8% ICAD vs 27.0% non-ICAD; p=0.82) or groin puncture to recanalization times (average 43.5 (range 8–181) min for ICAD vs 40.2 (4–204) min for non-ICAD; p=0.42). Patients with ICAD experienced a significantly higher number of passes (average 1.8 (range 1–7) passes for ICAD vs 1.6 (1–5) passes for non-ICAD; p=0.0059). Adjusting for age, ≥3 device passes, baseline National Institutes of Health Stroke Scale, rates of angioplasty only, rates of concurrent angioplasty and stenting, coronary artery disease and atrial fibrillation incidences, and time from emergency department arrival to recanalization, yielded no significant difference in rates of favorable outcomes between the two groups.

Conclusion Patients who underwent MT with underlying ICAD had similar rates of favorable outcomes as those without, but required a higher number of device passes.

  • atherosclerosis
  • thrombectomy
  • stenosis

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors AEH conceived the presented idea, and AEH and MCM planned the framework of data derivation. MCM wrote the manuscript in consultation with AEH, gathered angiographic data, and performed univariate and multivariate analysis. AAM verified univariate and multivariate analysis results. LP maintained endovascular database. Patients were seen by AEH, WT, and MCM Sr.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests AEH serves as a consultant and has receive Honoraria from Medtronic, Stryker, Microvention, Cerenovus, Penumbra, Balt,, Genentech, Scientia, and GE Healthcare.

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