title: Endovascular treatment for AIS with underlying ICAD.
abstract: BACKGROUND
  Acute large vessel occlusion (LVO) can result from thromboemboli or underlying intracranial atherosclerotic disease (ICAD). Although the technique for revascularization differs significantly for these two lesions (simple thrombectomy for thromboemboli and balloon angioplasty and stenting for ICAD), the underlying etiology is often unknown in acute ischemic stroke (AIS).
  
  
  OBJECTIVE
  To evaluate whether procedural complications, revascularization rates, and functional outcomes differ among patients with LVO from ICAD or thromboembolism.
  
  
  METHODS
  A retrospective review of thrombectomy cases from 2008 to 2015 was carried out for cases of AIS due to underlying ICAD. Thirty-six patients were identified. A chart and imaging review was performed to determine revascularization rates, periprocedural complications, and functional outcomes. Patients with ICAD and acute LVO were compared with those with underlying thromboemboli.
  
  
  RESULTS
  Among patients with ICAD and LVO, mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 12.9±8.5, revascularization (Thrombolysis In Cerebral Infarction, TICI ≥2b) was achieved in 22/34 (64.7%) patients, 11% had postprocedural intracerebral hemorrhage (PH2), and 14/33 (42.4%) had achieved a modified Rankin Scale (mRS) score of 0-2 at the 3-month follow-up. Compared with patients without underlying ICAD, there was no difference in NIHSS on presentation, or in the postprocedural complication rate. However, procedure times for ICAD were longer (98.5±59.8 vs 37.1±34.2 min), there was significant difference in successful revascularization rate between the groups (p=0.001), and a trend towards difference in functional outcome at 3 months (p=0.07).
  
  
  CONCLUSIONS
  Despite AIS with underlying ICAD requiring a more complex, technically demanding recanalization strategy than traditional thromboembolic AIS, it appears safe, and good outcomes are obtainable.
authors: Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA.
authors: Sami
authors: http://orcid.org/0000-0003-0593-6281
authors: S
authors: Al Kasab
authors: Medical University of South Carolina, School of Medicine, Charleston, South Carolina, USA.
authors: Zayed
authors: Z
authors: Almadidy
authors: Department of Neurosurgeruy, Medical University of South Carolina, Charleston, South Carolina, USA.
authors: Alejandro M
authors: AM
authors: Spiotta
authors: Department of Neurosurgeruy, Medical University of South Carolina, Charleston, South Carolina, USA.
authors: Aquilla S
authors: AS
authors: Turk
authors: Department of Neurosurgeruy, Medical University of South Carolina, Charleston, South Carolina, USA.
authors: M Imran
authors: MI
authors: Chaudry
authors: Department of Neurosurgeruy, Medical University of South Carolina, Charleston, South Carolina, USA.
authors: John P
authors: http://orcid.org/0000-0001-9668-3528
authors: JP
authors: Hungerford
authors: Department of Neurosurgeruy, Medical University of South Carolina, Charleston, South Carolina, USA.
authors: Raymond D
authors: RD
authors: Turner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: Angioplasty; Atherosclerosis; Balloon; Stroke; Thrombectomy