Introduction Mechanical thrombectomy is an established treatment for large vessel occlusion (LVO) in stroke. However, Intracranial Atherosclerotic Disease (ICAD) presenting as LVO can complicate mechanical thrombectomy and increase risks.

Aim of Study The aim of this study was to evaluate pre-thrombectomy imaging for ICAD and assess the predictive value of the hyperdense artery sign on CT head and the tapering sign on CT angiography, respectively.

Methods A retrospective radiological review of ICAD cases was conducted using data from the institutional thrombectomy database. Patients who underwent thrombectomy for large vessel occlusion were selected, and a control group without ICAD was matched to the ICAD group based on age and thrombus location.

Results The study included 26 patients, with 13 diagnosed with ICAD. The mean age of the patients was 56.6±16.1 years. The ICAD group had a lower prevalence of hyperdense thrombus compared to the non-ICAD group (30.8% vs. 84.6%; p<0.01), resulting in a sensitivity of 30.8% and a specificity of 15.4% for detecting ICAD. Tapering at the occlusion site on CT angiography was observed more frequently in the ICAD group (53.8% vs. 7.7%; p=0.01), resulting in a sensitivity of 53.9% and a specificity of 92.3% for detecting ICAD. The results demonstrated perfect agreement between the two readers.

Conclusion Our findings suggest a significant association between the absence of the hyperdense artery sign and the presence of tapering at the occlusion site with ICAD in patients with LVO. Incorporating these signs in pre-thrombectomy evaluation has the potential to improve stroke care.

Disclosure of Interest Dr. Joe Leyon has/had consultancy agreements with Microvention Terumo, Medtronic, and Stryker Neurovascular.