Large Vessel Occlusion Stroke due to Intracranial Atherosclerotic Disease: Identification, Medical and Interventional Treatment, and Outcomes

Adam De Havenon, Osama O. Zaidat, Sepideh Amin-Hanjani, Thanh N. Nguyen, Aaron Bangad, Mehdi Abbasi, Mohammad Anadani, Eyad Almallouhi, Rano Chatterjee, Mikael Mazighi, Eva A. Mistry, Shadi Yaghi, Colin P. Derdeyn, Keun Sik Hong, Alexandra Kvernland, Thabele M. Leslie-Mazwi, Sami Al Kasab

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations

Abstract

Large vessel occlusion stroke due to underlying intracranial atherosclerotic disease (ICAD-LVO) is prevalent in 10 to 30% of LVOs depending on patient factors such as vascular risk factors, race and ethnicity, and age. Patients with ICAD-LVO derive similar functional outcome benefit from endovascular thrombectomy as other mechanisms of LVO, but up to half of ICAD-LVO patients reocclude after revascularization. Therefore, early identification and treatment planning for ICAD-LVO are important given the unique considerations before, during, and after endovascular thrombectomy. In this review of ICAD-LVO, we propose a multistep approach to ICAD-LVO identification, pretreatment and endovascular thrombectomy considerations, adjunctive medications, and medical management. There have been no large-scale randomized controlled trials dedicated to studying ICAD-LVO, therefore this review focuses on observational studies.

Original languageEnglish
Pages (from-to)1695-1705
Number of pages11
JournalStroke
Volume54
Issue number6
DOIs
StatePublished - Jun 1 2023

Keywords

  • intracranial atherosclerosis
  • mortality
  • risk factors
  • stroke
  • thrombectomy

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