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 Jul 01 TA - American Journal of Neuroradiology PG - ajnr.A8399 4099 - http://www.ajnr.org/content/early/2024/07/01/ajnr.A8399.short 4100 - http://www.ajnr.org/content/early/2024/07/01/ajnr.A8399.full AB - BACKGROUND AND PURPOSE: Reocclusion after treatment is a concern in endovascular therapy (EVT) for isolated intracranial atherothrombotic stroke-related large vessel occlusion (AT-LVO). However, the optimal EVT technique for AT-LVO has not yet been investigated. This study evaluated the optimal EVT 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 three groups based on the EVT technique: mechanical thrombectomy alone (MT-only), percutaneous transluminal angioplasty (PTA), and stent deployment (Stent). MT alone was classified into the MT-only group, PTA and MT-PTA into the PTA group, and MT-Stent, MT-PTA-Stent, PTA-Stent, and Stent-only into the Stent group. The primary outcome was the incidence of reocclusion of the treated vessels within 90 days of EVT completion.RESULTS: We enrolled 770 patients and analyzed 509 patients. The rates in the MT-only, PTA, and Stent groups were 40.7, 44.4, and 14.9%, respectively. The incidence rate of residual stenosis >70% of final angiography was significantly higher in the MT-only group than in the PTA and Stent groups (MT-only vs. PTA vs. Stent: 34.5% vs. 26.3% vs. 13.2%, p=0.002). The reocclusion rate was significantly lower in the PTA group than in the MT-only group (adjusted hazard ratio [95% confidence interval], 0.48 [0.29–0.80]). Of the patients, 83.5% experienced reocclusion within 10 days after EVT. Alarmingly, a substantial subset (approximately 62.0%) of patients underwent reocclusion within 2 days of EVT. The incidence of modified Rankin scale scores of 0–2 90 days after EVT was not significantly different among the three groups. The incidences of symptomatic intracranial hemorrhage (ICH), any other ICH, and death were not significantly different.CONCLUSIONS: The incidence rate of reocclusion was significantly lower in the PTA group than in the MT-only group. We found no significant difference in reocclusion rates between the Stent and MT-only groups. In Japan, GP IIb/IIIa inhibitors are not reimbursed. Therefore, PTA might be the preferred choice for AT-LVOs due to the higher reocclusion risk with MT-only. Reocclusion was likely to occur within 10 days, particularly within 2 days post-EVT.ABBREVIATIONS: EVT = endovascular treatment; LVO = large vessel occlusion; MT = mechanical thrombectomy; PTA = percutaneous transluminal angioplasty; ICH = intracranial hemorrhage; SD = standard deviation; IQR = interquartile range; HRs = hazard ratios; BMI = body mass index; LDL = low-density lipoprotein; HDL = high-density lipoprotein; DAPT = dual antiplatelet therapy; TAPT = triple antiplatelet therapy