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, Arindam Chatterjee, Mikaël Mazighi, Eva Mistry, Shadi Yaghi, Colin P. Derdeyn, Keun‐Sik Hong, Alexandra Kvernland, Thabele M Leslie‐Mazwi, Sami Al Kasab
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.