Mechanical Thrombectomy For Endovascular Treatment For Non-acute Symptomatic Intracranial Large Artery Occlusions

Objective:Endovascular treatment(EVT)has shown great promise in individuals with non-acute symptomatic intracranial large artery occlusions.Angioplasty and stenting have been proposed for revascularization,with varying rates of angiographic and clinical success,while mechanical thrombectomy with a stent retriever is less often mentioned.The purpose of this study was to evaluate the efficacy and safety of mechanical thrombectomy for endovascular treatment in real-world patients with symptomatic non-acute intracranial large artery occlusions.Methods:We conducted a retrospective cohort analysis of 72 subjects who underwent endovascular recanalization for non-acute symptomatic intracranial large artery occlusions at the stroke center of the First Hospital of Jilin University from January 2019 to March 2022.Patients were segmented into 2 groups: those receiving mechanical thrombectomy for endovascular treatment(EVT with mechanical thrombectomy,n=31)and those using stenting and angioplasty only during the procedure(EVT without mechanical thrombectomy,n=41).The following treatment outcomes were compared: technical success,stroke and death within 30 days,stroke and death beyond 30 days,90-day functional outcome,and restenosis.Results:Overall,successful recanalization was accomplished in 91.7% of patients(66/72)following endovascular treatment.Stroke and death within 30 days were observed in 18.1%(13/72)of patients,with 9patients(12.5%)having an ischemic stroke and 4(5.6%)having a hemorrhagic stroke.There was no death after the procedure within 30 days.During the course of the median 14.5-month clinical follow-up period,70 patients(97.2%)had clinical follow-up data and 4 patients(5.7%)of them experienced recurrent ischemic stroke with no one occurring hemorrhagic stroke or dying of stroke during the follow-up post-index procedure.Within a median of 7 months 57(79.2%)underwent vascular follow-up imaging with transcranial Doppler ultrasound,and restenosis was identified in 24.6% of them.The rate of restenosis was significantly lower in the group of EVT with mechanical thrombectomy than in the EVT without mechanical thrombectomy group(11.5% versus 35.5%,P=0.036).The independent predictor of restenosis was the occlusion site which was located in the anterior circulation in multivariate logistic regression analysis.In the subgroup of patients(n=54)who had vertebrobasilar artery occlusion,patients undergoing mechanical thrombectomy also had a decreased rate of restenosis,but the difference was not statistically significant(4.3% versus 23.8%,P=0.150).The rates of technical success,stroke and death within 30 days,stroke and death beyond 30 days,and 90-day functional outcome were not significantly different between the 2 groups.Conclusion:The present study suggests that mechanical thrombectomy for endovascular treatment is safe and effective,associated with a decreased rate of restenosis of treated arteries,for non-acute symptomatic intracranial large artery occlusions.