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PT  - JOURNAL ARTICLE
AU  - Beppu, Mikiya
AU  - Uchida, Kazutaka
AU  - Sakai, Nobuyuki
AU  - Yamagami, Hiroshi
AU  - Toyoda, Kazunori
AU  - Matsumaru, Yuji
AU  - Matsumoto, Yasushi
AU  - Todo, Kenichi
AU  - Hayakawa, Mikito
AU  - Shindo, Seigo
AU  - Ota, Shinzo
AU  - Morimoto, Masafumi
AU  - Takeuchi, Masataka
AU  - Imamura, Hirotoshi
AU  - Ikeda, Hiroyuki
AU  - Tanaka, Kanta
AU  - Ishihara, Hideyuki
AU  - Kakita, Hiroto
AU  - Sano, Takanori
AU  - Araki, Hayato
AU  - Nomura, Tatsufumi
AU  - Sakakibara, Fumihiro
AU  - Shirakawa, Manabu
AU  - Yoshimura, Shinichi
AU - for the RESCUE AT-LVO Investigators
TI  - Optimal Endovascular Therapy Technique for Isolated Intracranial Atherothrombotic Stroke-Related Large-Vessel Occlusion in the Acute-to-Subacute Stage
AID  - 10.3174/ajnr.A8399
DP  - 2024 Nov 01
TA  - American Journal of Neuroradiology
PG  - 1692--1700
VI  - 45
IP  - 11
4099  - http://www.ajnr.org/content/45/11/1692.short
4100  - http://www.ajnr.org/content/45/11/1692.full
SO  - Am. J. Neuroradiol.2024 Nov 01; 45
AB  - BACKGROUND AND PURPOSE: Reocclusion after treatment is a concern in endovascular therapy for isolated intracranial atherothrombotic stroke-related large-vessel occlusion (AT-LVO). However, the optimal endovascular therapy technique for AT-LVO has not yet been investigated. This study evaluated the optimal endovascular therapy technique for AT-LVO in a real-world setting.MATERIALS AND METHODS: We conducted a historical, multicenter registry study at 51 centers that enrolled patients with AT-LVO. We divided the patients into 3 groups based on the endovascular therapy technique: mechanical thrombectomy alone, percutaneous transluminal angioplasty (PTA), and stent deployment. Mechanical thrombectomy alone was classified into the mechanical thrombectomy-only group; PTA and mechanical thrombectomy–PTA, into the PTA group; and mechanical thrombectomy–stent deployment, mechanical thrombectomy–PTA–stent deployment, PTA–stent deployment, and stent deployment–only into the stent group. The primary outcome was incidence of reocclusion of the treated vessels within 90 days of endovascular therapy completion.RESULTS: We enrolled 770 patients and analyzed 509 patients. The rates in the mechanical thrombectomy-only, PTA, and stent deployment groups were 40.7%, 44.4%, and 14.9%, respectively. Incidence rate of residual stenosis &amp;gt;70% of final angiography was significantly higher in the mechanical thrombectomy-only group than in the PTA and stent deployment groups (mechanical thrombectomy-only versus PTA versus stent deployment: 34.5% versus 26.3% versus 13.2%, P = .002). Reocclusion rate was significantly lower in the PTA group than in the mechanical thrombectomy-only group (adjusted hazard ratio, 0.48; 95% CI, 0.29–0.80). Of the patients, 83.5% experienced reocclusion within 10 days after endovascular therapy. Alarmingly, a substantial subset (approximately 62.0%) of patients experienced reocclusion within 2 days of endovascular therapy. Incidence of mRS scores of 0–2 ninety days after endovascular therapy was not significantly different among the 3 groups. Incidences of symptomatic intracranial hemorrhage, any other intracranial hemorrhage, and death were not significantly different.CONCLUSIONS: Incidence rate of reocclusion was significantly lower in the PTA group than in the mechanical thrombectomy-only group. We found no meaningful difference in reocclusion rates between the stent deployment and mechanical thrombectomy-only groups. In Japan, glycoprotein IIb/IIIa inhibitors are not reimbursed. Therefore, PTA might be the preferred choice for AT-LVOs due to the higher reocclusion risk with mechanical thrombectomy-only. Reocclusion was likely to occur within 10 days, particularly within 2 days post-endovascular therapy.AT-LVOatherothrombotic stroke-related large-vessel occlusionDAPTdual antiplatelet therapyEVTendovascular treatmentGPglycoproteinHRhazard ratioICHintracranial hemorrhageLVOlarge-vessel occlusionMTmechanical thrombectomyPTApercutaneous transluminal angioplastyStentstent deploymentTAPTtriple antiplatelet therapy