title: Special Endovascular Treatment for Acute Large Artery Occlusion Resulting From Atherosclerotic Disease.
abstract: BACKGROUND
  Acute intracranial atherosclerotic disease (IAD)-related large artery occlusion (LAO) is typically refractory to mechanical thrombectomy. We evaluated the feasibility and safety of emergency balloon-assisted or stent-assisted angioplasty performed with tirofiban administration for acute IAD-related LAO.
  
  
  METHODS
  We identified, from among 55 consecutive patients who underwent endovascular treatment for LAO, 12 patients with acute IAD-related LAO who underwent balloon-assisted or stent-assisted angioplasty with (n = 3) or without passage of a stent retriever. The treatment included tirofiban administration. We obtained, from patients' clinical records, thrombolysis in cerebral infarction scores (to assess the extent of reperfusion), follow-up magnetic resonance angiography images (to assess patency of the responsive arteries), and 90-day modified Rankin (mRS) scores (to assess outcomes).
  
  
  RESULTS
  Temporary blood flow and severe stenosis were observed angiographically in all 12 patients, either when the stent retriever was deployed or when a microcatheter was advanced through the site of occlusion. Persistent recanalization was achieved in all patients, and there was no operative complication or arterial reocclusion. All 8 patients with an occluded major artery in the anterior circulation had a good outcome, with an mRS score of ≤2. Two of the 4 patients with basilar artery occlusion had a good outcome, with an mRS score of ≤2. One patient (25%) died within 72 hours after procedure.
  
  
  CONCLUSIONS
  Our data point to the safety and feasibility of emergency balloon-assisted or stent-assisted angioplasty performed with tirofiban administration and a single or no passage of the stent retriever for acute IAD-related LAO.
authors.affiliation: Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China.
authors.forename: Ting-Yu
authors.initials: TY
authors.lastname: Yi
authors.affiliation: Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China. Electronic address: doctorwwenhuo@126.com.
authors.forename: Wen-Huo
authors.initials: WH
authors.lastname: Chen
authors.affiliation: Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China.
authors.forename: Yan-Min
authors.initials: YM
authors.lastname: Wu
authors.affiliation: Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China.
authors.forename: Mei-Fang
authors.initials: MF
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China.
authors.forename: Yue-Hong
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China.
authors.forename: Zong-Zhong
authors.initials: ZZ
authors.lastname: Wu
authors.affiliation: Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China.
authors.forename: Yan-Chuan
authors.initials: YC
authors.lastname: Shi
authors.affiliation: Department of Neurology, Zhangzhou-affiliated Hospital of Fujian Medical University, Fujian, People's Republic of China.
authors.forename: Bai-Ling
authors.initials: BL
authors.lastname: Chen
mesh_terms: D000368:Aged; D017130:Angioplasty; D000800:Angioplasty, Balloon; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D004630:Emergencies; D057510:Endovascular Procedures; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000628:therapy*; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute occlusion; Arteriosclerosis; Emergent angioplasty; Intracranial large artery