title: Importance of truncal-type occlusion in stentriever-based thrombectomy for acute stroke.
abstract: OBJECTIVE
  To investigate whether angiographically defined occlusion type could predict of the etiology of acute intracranial large artery occlusion and the stentriever response.
  
  
  METHODS
  We reviewed consecutive patients with acute intracranial large artery occlusion who underwent endovascular treatment and examined their workups for embolic sources. Patient demographics, laboratory findings, hyperdense artery sign, and angiographic occlusion type (truncal-type or branching-site occlusion) were compared between embolic sources (+) and (-) groups. These variables were also compared between stentriever failure and success groups. Details of endovascular procedures were also compared according to occlusion type.
  
  
  RESULTS
  A total of 259 patients (mean age 70.3 years; M:F = 132:127) were finally included. Of these patients, 216 (83.4%) were assigned to the embolic sources (+) group after thorough evaluation. Young age, no coronary artery disease, and truncal-type occlusion (odds ratio [OR] 9.07; 95% confidence interval [CI] 3.74-22.0) were independently associated with the embolic source (-) group. Of the overall group, 224 patients (86.5%) underwent stentriever-based endovascular treatment. Hypertension, diabetes, high C-reactive protein level, and truncal-type occlusion (OR 32.2; 95% CI 7.78-133.0) were independent predictors of stentriever failure. Truncal-type occlusion was associated with more reocclusion (77.3% vs 5.0%), resulting in recanalization failure by the stentriever (81.8% vs 20.3%), a longer puncture-to-recanalization time (118.0 vs 49.5 minutes), and more rescue treatment for final successful recanalization (78.9% vs 7.0%).
  
  
  CONCLUSIONS
  Angiographic occlusion type is an independent predictor of stentriever refractoriness and of the underlying stroke mechanism.
authors.affiliation: From the Department of Neurology (J.-H.B.), National Medical Center; Departments of Radiology (B.M.K., D.J.K.) and Neurology (J.H.H., H.S.N., D.S.), Severance Hospital Stroke Center, Yonsei University College of Medicine; and Department of Neurology (O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jang-Hyun
authors.initials: JH
authors.lastname: Baek
authors.affiliation: From the Department of Neurology (J.-H.B.), National Medical Center; Departments of Radiology (B.M.K., D.J.K.) and Neurology (J.H.H., H.S.N., D.S.), Severance Hospital Stroke Center, Yonsei University College of Medicine; and Department of Neurology (O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. bmoon21@hanmail.net.
authors.forename: Byung Moon
authors.initials: BM
authors.lastname: Kim
authors.affiliation: From the Department of Neurology (J.-H.B.), National Medical Center; Departments of Radiology (B.M.K., D.J.K.) and Neurology (J.H.H., H.S.N., D.S.), Severance Hospital Stroke Center, Yonsei University College of Medicine; and Department of Neurology (O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: From the Department of Neurology (J.-H.B.), National Medical Center; Departments of Radiology (B.M.K., D.J.K.) and Neurology (J.H.H., H.S.N., D.S.), Severance Hospital Stroke Center, Yonsei University College of Medicine; and Department of Neurology (O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
authors.affiliation: From the Department of Neurology (J.-H.B.), National Medical Center; Departments of Radiology (B.M.K., D.J.K.) and Neurology (J.H.H., H.S.N., D.S.), Severance Hospital Stroke Center, Yonsei University College of Medicine; and Department of Neurology (O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hyo Suk
authors.initials: HS
authors.lastname: Nam
authors.affiliation: From the Department of Neurology (J.-H.B.), National Medical Center; Departments of Radiology (B.M.K., D.J.K.) and Neurology (J.H.H., H.S.N., D.S.), Severance Hospital Stroke Center, Yonsei University College of Medicine; and Department of Neurology (O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dongbeom
authors.initials: D
authors.lastname: Song
authors.affiliation: From the Department of Neurology (J.-H.B.), National Medical Center; Departments of Radiology (B.M.K., D.J.K.) and Neurology (J.H.H., H.S.N., D.S.), Severance Hospital Stroke Center, Yonsei University College of Medicine; and Department of Neurology (O.Y.B.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Bang
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002533:Cerebral Angiography; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D062606:Tertiary Care Centers; D017131:Thrombectomy; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers