Journal
STROKE
Volume 54, Issue 6, Pages 1695-1705Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/STROKEAHA.122.040008
Keywords
intracranial atherosclerosis; mortality; risk factors; stroke; thrombectomy
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Large vessel occlusion stroke due to underlying intracranial atherosclerotic disease (ICAD-LVO) accounts for 10 to 30% of LVOs, and patients with ICAD-LVO can benefit from endovascular thrombectomy. However, reocclusion after revascularization is common in these patients. This review focuses on the identification, treatment planning, and medical management of ICAD-LVO, and emphasizes the need for further research in this area.
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.
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