Effect of Intracranial Atherosclerotic Disease on Endovascular Treatment for Patients with Acute Vertebrobasilar Occlusion.
OBJECTIVE
Although intracranial atherosclerotic disease is often encountered during endovascular treatment for acute vertebrobasilar occlusions, its clinical implication is not well-known. We aimed to evaluate whether intracranial atherosclerotic disease influences the clinical outcomes following endovascular treatment of acute vertebrobasilar occlusive stroke.


METHODS
Fifty-one patients with acute vertebrobasilar occlusive stroke were included. The onset-to-groin puncture time was ≤12 hours, and aspiration- or stent-based thrombectomy was used as the primary treatment method. Following primary endovascular treatment, intracranial atherosclerotic disease (IAD group) was angiographically diagnosed when a fixed focal stenosis was observed at the occlusion site, whereas embolism (embolic group) was diagnosed if no stenosis was observed. Clinical and treatment variables were compared in both groups, and IAD was evaluated as a prognostic factor for clinical outcomes.


RESULTS
The baseline NIHSS score tended to be lower (14 versus 22,P= .097) in the IAD group (n= 19) than in the embolic group (n= 32). The procedural time was longer in the IAD group (96 versus 61 minutes,P= .002), despite similar rates of TICI 2b-3 (89.5% versus 87.5%,P= 1.000). The NIHSS score at 7 days was higher (21 versus 8,P= .060) and poor outcomes (mRS 4-6 at 3 months) were more frequent in the IAD group (73.7% versus 43.8%,P= .038). IAD (odds ratio, 5.469; 95% CI, 1.09-27.58;P= .040) was independently associated with poor outcomes.


CONCLUSIONS
An arterial occlusion related to IAD was associated with a longer procedural time and poorer clinical outcome. Further studies are warranted to elucidate the appropriate endovascular strategy.
From the Departments of Neurology (Y.W.K., Y.H.H.).|Radiology (Y.W.K., D.-H.K., Y.S.K.).
Y W
http://orcid.org/0000-0003-0674-0352
YW
Kim
Departments of Neurology (J.M.H., D.G.P., J.S.L.).
J M
http://orcid.org/0000-0001-6803-1207
JM
Hong
Departments of Neurology (J.M.H., D.G.P., J.S.L.).
D G
http://orcid.org/0000-0001-8658-3523
DG
Park
Radiology (J.W.C.), Ajou University School of Medicine and Hospital, Suwon, Republic of Korea.
J W
http://orcid.org/0000-0002-2396-4705
JW
Choi
Radiology (Y.W.K., D.-H.K., Y.S.K.).|Neurosurgery (D.-H.K.), Kyungpook National University School of Medicine and Hospital, Daegu, Republic of Korea.
D-H
http://orcid.org/0000-0002-2977-9340
DH
Kang
Radiology (Y.W.K., D.-H.K., Y.S.K.).
Y S
http://orcid.org/0000-0002-0725-5706
YS
Kim
Radiology (J.W.C.), Ajou University School of Medicine and Hospital, Suwon, Republic of Korea.
O O
http://orcid.org/0000-0003-4881-4698
OO
Zaidat
Radiology (J.W.C.), Ajou University School of Medicine and Hospital, Suwon, Republic of Korea.
A M
http://orcid.org/0000-0002-4930-7789
AM
Demchuk
From the Departments of Neurology (Y.W.K., Y.H.H.) jinsoo22@gmail.com yangha.hwang@gmail.com.
Y H
http://orcid.org/0000-0002-6665-7481
YH
Hwang
Departments of Neurology (J.M.H., D.G.P., J.S.L.) jinsoo22@gmail.com yangha.hwang@gmail.com.
J S
http://orcid.org/0000-0002-7225-6166
JS
Lee