Endovascular Therapy for Progressive Stroke due to Intracranial Atherosclerotic Large Vessel Occlusion Beyond the 24-Hour Time Window: A Single-Center Retrospective Cohort Study

Background

The optimal management for treating progressive strokes caused by anterior circulation intracranial atherosclerotic large vessel occlusion (ICAS-LVO) remains unclear.

Methods

A retrospective analysis was conducted on our stroke database. Among the patients presenting with mild ischemic stroke (National Institutes of Health Stroke Scale ≤5), 273 were diagnosed with anterior circulation ICAS-LVO. Forty-five patients who experienced neurologic deterioration (National Institutes of Health Stroke Scale increase ≥4) between 24 hours to 7 days poststroke, despite a persistent ischemic penumbra on computed tomography perfusion, were retrospectively identified. These patients were allocated to either the endovascular-therapy group or the medical-therapy group based on their receipt of endovascular intervention. The modified Rankin scale score at 90 days, the rate of technically successful recanalization, and perioperative complications were assessed.

Results

Of the 45 patients, 27 underwent endovascular therapy, and 18 received medical therapy. Recanalization was technically successful in all cases within the endovascular group. The preferred treatment was direct angioplasty, with 12 patients receiving balloon angioplasty alone, 11 receiving balloon angioplasty and stent implantation, and 4 undergoing balloon angioplasty followed by mechanical thrombectomy. The rate of functional independence (modified Rankin scale ≤2) at 90 days was significantly higher in the endovascular group (74.1%) compared to the medical group (33.3%, risk ratio 5.714; 95% confidence interval, 1.55 to 21.06; P = 0.007). The incidence of intracranial hemorrhage was slightly higher in the endovascular group, but not statistically significant.

Conclusions

Endovascular therapy may offer a viable treatment option for progressive stroke resulting from anterior circulation ICAS-LVO, even when the time from stroke onset to treatment exceeds 24 hours, in select patients.