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Front. Neurol. | doi: 10.3389/fneur.2019.00308

Endovascular treatment of acute stroke due to intracranial atherosclerotic stenosis-related large vessel occlusion

Hyungjong Park1,  Jang-Hyun Baek2 and  Byung Moon Kim1*
  • 1Yonsei University College of Medicine, South Korea
  • 2National Medical Center, South Korea

Modern endovascular treatment (EVT) has become a standard treatment for acute ischemic stroke due to large vessel occlusion (LVO) in the anterior circulation. However, whether modern EVT tools used for intracranial atherosclerotic stenosis (ICAS)-related LVO are as safe and effective as for use in embolic LVO remains unclear. There have been only a few studies about EVT for ICAS-related LVO, and these studies revealed that modern thrombectomy with a stent retriever or contact aspiration was less effective and more time consuming in ICAS-related LVO than in embolic LVO. Because fast and successful recanalization (defined as modified Thrombolysis in Cerebral Ischemia grade, 2b or 3) is the most critical factor influencing favorable outcomes, it is important to determine the appropriate EVT strategy for fast recanalization of ICAS-related LVO. In this report, we review the results of modern thrombectomy using stent retriever or contact aspiration and rescue treatments after failure of modern thrombectomy for ICAS-related LVO. Finally, we propose the EVT strategy appropriate for ICAS-related LVO based on a literature review and our experience.

Keywords: acute stroke, Large vessel occlusion, Intracranial atherosclerosis, endovascular treatment, stenosis and cerebrovascular occlusion

Received: 15 Sep 2018; Accepted: 11 Mar 2019.

Edited by:

Osama O. Zaidat, Northeast Ohio Medical University, United States

Reviewed by:

Yang-Ha HWANG, Kyungpook National University, South Korea
Seong-Joon Lee, School of Medicine, Ajou University, South Korea
Mohammad El-Ghanem, University of Arizona, United States  

Copyright: © 2019 Park, Baek and Kim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Byung Moon Kim, Yonsei University College of Medicine, Seoul, South Korea, bmoon21@yuhs.ac