Endovascular recanalization of symptomatic non–acute intracranial artery occlusion: Procedural and mid-term clinical outcomes in the anterior circulation

Abstract

Objective

Symptomatic non–acute intracranial arterial occlusion (NAICO) is not uncommon. We report a single-center experience of the feasibility and safety of endovascular treatment of anterior circulation NAICO and summarize the outcomes of patient groups with successful or failed recanalization.

Methods

Patients who underwent endovascular therapy for intracranial arterial stenosis between January 2010 and May 2017 were retrospectively reviewed. Thirty-eight patients with symptomatic NAICO (symptom onset > 24 hours) in the anterior circulation were identified.

Results

Successful recanalization was achieved in 76.3% of patients (29/38). Intraprocedural events occurred in 10.5% (4/38), including intima dissection (n = 1), parent artery rupture (n = 1) and acute in-stent thrombosis (n = 2).

Mean follow-up duration after successful recanalization was 36.5 months. One patient died 68 days after the procedure because of a newly developed posterior circulation stroke. Acute reocclusion was observed in two patients (6.7%); subacute or delayed reocclusion was observed in three patients (10%). Good final outcome (modified Rankin Scale score ≤ 2) was achieved in 25 of 28 patients (89.3%) at three months.

Mean follow-up duration of the nine patients with failed recanalization was 41.4 months. Three patients underwent extra–intracranial bypass for worsening symptoms. The other six patients showed stable or improved neurological status with antiplatelet medications. Good final outcome was achieved in eight of nine patients (88.9%) at three months.

Conclusions

Endovascular revascularization can be a viable option with an acceptable safety profile in selected patients with symptomatic NAICO in the anterior circulation. Further characterization of aborted cases would facilitate proper patient selection for endovascular treatment.

Keywords

Intracranial occlusion outcomes stenting

Get full access to this article

View all access options for this article.

References

Chimowitz

Derdeyn

. Endovascular therapy for atherosclerotic intracranial arterial stenosis: Back to the drawing board. JAMA 2015; 313: 1219–1220.

Chimowitz

Lynn

Derdeyn

et al.

Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 2011; 365: 993–1003.

Yamauchi

Higashi

Kagawa

et al.

Chronic hemodynamic compromise and cerebral ischemic events in asymptomatic or remote symptomatic large-artery intracranial occlusive disease. AJNR Am J Neuroradiol 2013; 34: 1704–1710.

Aghaebrahim

Jovin

Jadhav

et al.

Endovascular recanalization of complete subacute to chronic atherosclerotic occlusions of intracranial arteries. J Neurointerv Surg 2014; 6: 645–648.

Gifford

Drazin

Dalfino

et al.

The effectiveness of microballoon angioplasty in treating middle cerebral artery occlusion beyond the bifurcation. AJNR Am J Neuroradiol 2010; 31: 1541–1548.

Kansara

Pandey

Tiwari

et al.

Stenting of acute and subacute intracranial vertebrobasilar arterial occlusive lesions. J Neurointerv Surg 2012; 4: 274–280.

Guo

et al.

Stent-assisted mechanical recanalization for symptomatic subacute or chronic middle cerebral artery occlusion. Int J Clin Exp Med 2015; 8: 21818–21821.

Wang

et al.

Enterprise stent in recanalizing non-acute atherosclerotic intracranial internal carotid artery occlusion. Clin Neurol Neurosurg 2017; 162: 47–52.

et al.

Endovascular recanalization for chronic symptomatic intracranial vertebral artery total occlusion. Minim Invasive Surg 2014; 2014: 949585.

10.

Samuels

Joseph

Lynn

et al.

A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol 2000; 21: 643–646.

11.

Park

et al.

Intracranial stenting of subacute symptomatic atherosclerotic occlusion versus stenosis. Stroke 2011; 42: 3470–3476.

12.

Lee

Hong

Kim

. Diagnostic and therapeutic strategies for acute intracranial atherosclerosis-related occlusions. J Stroke 2017; 19: 143–151.

13.

Jia

Lee

Kim

et al.

Optimal guiding catheter length for endovascular coiling of intracranial aneurysms in anterior circulation in era of flourishing distal access system. Neurointervention 2017; 12: 91–99.

14.

Hwang

Kim

Kang

et al.

Impact of target arterial residual stenosis on outcome after endovascular revascularization. Stroke 2016; 47: 1850–1857.

15.

Sung

Lee

et al.

Emergent intracranial stenting for acute M2 occlusion of middle cerebral artery. Clin Neurol Neurosurg 2014; 119: 110–115.

16.

Gonzalez

Dusick

Connolly

et al.

Encephaloduroarteriosynangiosis for adult intracranial arterial steno-occlusive disease: Long-term single-center experience with 107 operations. J Neurosurg 2015; 123: 654–661.

17.

Yang

Jiao

et al.

Superficial temporal artery-middle cerebral artery bypass surgery for refractory symptomatic intracranial atherosclerotic stenosis. World Neurosurg 2017; 104: 74–81.

18.

Krischek

Miloslavski

Fischer

et al.

A comparison of functional and physical properties of self-expanding intracranial stents [Neuroform3, Wingspan, Solitaire, Leo+, Enterprise]. Minim Invasive Neurosurg 2011; 54: 21–28.