AUTHOR=Chuming Huang , Yifan Hong , Ke Xu , Chukai Xu , Weijie Zhang , Hui Li , Guoyi Peng , Xiaoyong Zhang , Peifeng Zhang , Chuwei Cai 

TITLE=Association Between Occlusion Type and Etiology of Acute Intracranial Large Artery Occlusion

JOURNAL=Frontiers in Neurology

VOLUME=Volume 11 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.582388

DOI=10.3389/fneur.2020.582388

ISSN=1664-2295

ABSTRACT=Abstract
Objective: To investigate the diagnostic efficiency of truncal-type occlusion (TTO) and branching-site occlusion (BSO) in determining the etiology of acute intracranial large artery occlusion (ILAO)-related ischemic stroke (AIS).
Methods: Patients with ILAO-related AIS who received stent retriever (SR) thrombectomy from November 2014 to June 2019 were included. All patients underwent angiography, which was used to evaluate whether the ILAO was due to intracranial atherosclerosis (ICAS) or embolism. Differences in the distribution of occlusion types in ICAS and in embolism were assessed and the diagnostic indicators, including the area under the ROC curve (AUC), sensitivity and specificity were calculated.
Results: Of the 115 AIS patients with ILAO, 42 were classified as having ICAS, and 73 having an embolism. In the ICAS group, BSO was responsible for 3 (7%) cases and TTO for 39 (93%) cases, while in the embolism group, BSO was responsible for 66 (90%) cases and TTO for 7 (10%) cases; the difference was statistically significant (all P<0.01). The AUC for ICAS predicted by TTO was 0.916, with a sensitivity of 92.86%, and specificity of 90.41%. 
Conclusion: TTO showed a high predictability of ICAS. Determine the etiology of ILAO-related AIS before SR thrombectomy may be most helpful in setting up optimal endovascular treatment strategies.